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实地记录:托珠单抗与瑞德西韦联合治疗重症新型冠状病毒肺炎合并细胞因子释放综合征1例

Notes From the Field: The Combined Effects of Tocilizumab and Remdesivir in a Patient With Severe COVID-19 and Cytokine Release Syndrome.

作者信息

Ali Sabahat, Khalid Sundas, Afridi Maham, Akhtar Samar, Khader Yousef S, Akhtar Hashaam

机构信息

Department Of Gynecology And Obstetrics, Pakistan Air Force Hospital, Islamabad, Pakistan.

School of Chemical and Materials Engineering, National University of Science and Technology, Islamabad, Pakistan.

出版信息

JMIR Public Health Surveill. 2021 May 19;7(5):e27609. doi: 10.2196/27609.

Abstract

SARS-CoV-2 is known to cause severe bilateral pneumonia and acute respiratory distress syndrome or COVID-19 in patients, which can be debilitating and even fatal. With no drugs or vaccines available yet, a wide range of treatment regimens used are being repurposed. The need of the hour is to analyze various currently available regimens and devise a treatment plan that is most effective for COVID-19. Here we describe the case of a 68-year-old man with hypertension and diabetes, exhibiting symptoms of cough and shortness of breath, who presented at the emergency department of our hospital. Chest computed tomography revealed bilateral ground glass opacities that were indicative of COVID-19, and a computed tomography score of 24 was indicative of severe pulmonary pneumonia. He tested positive for COVID-19. His treatment regimen included the use of convalescent plasma, oxygen therapy, steroids, high-dose antibiotics, broad-spectrum antiviral remdesivir, and anti-interleukin-6 monoclonal antibody (Tocilizumab) at various stages of the disease. Oxygen supplementation was required at the time of admission. The patient initially developed a cytokine release storm, and oxygen supplementation was initiated to manage his condition. Supportive care and multiple treatment regimens were used to successfully recover the patient's health. With a rapid increase in number of confirmed cases worldwide, COVID-19 has become a major challenge to our health care system. With no available vaccines currently, the establishment of a combination of therapeutic drugs that effectively reduce disease progression is of utmost importance.

摘要

已知严重急性呼吸综合征冠状病毒2(SARS-CoV-2)可导致患者出现严重双侧肺炎和急性呼吸窘迫综合征,即2019冠状病毒病(COVID-19),这可能使人虚弱,甚至致命。由于目前尚无药物或疫苗,正在对广泛使用的各种治疗方案进行重新调整用途。当务之急是分析各种现有方案,并制定出对COVID-19最有效的治疗计划。在此,我们描述一名68岁患有高血压和糖尿病的男性病例,该患者出现咳嗽和呼吸急促症状,前来我院急诊科就诊。胸部计算机断层扫描显示双侧磨玻璃影,提示为COVID-19,计算机断层扫描评分为24分提示为重症肺炎。他的COVID-19检测呈阳性。他的治疗方案在疾病的不同阶段包括使用康复期血浆、氧疗、类固醇、大剂量抗生素、广谱抗病毒药物瑞德西韦以及抗白细胞介素-6单克隆抗体(托珠单抗)。入院时需要吸氧。患者最初出现细胞因子释放风暴,遂开始吸氧以控制病情。通过支持治疗和多种治疗方案,患者成功康复。随着全球确诊病例数迅速增加,COVID-19已成为我们医疗系统面临的一项重大挑战。由于目前尚无可用疫苗,建立一套能有效减缓疾病进展的联合治疗药物至关重要。

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