Faculty of Medicine-Pulmonary Disease, University of Medicine and Pharmacy Grigore T Popa, Iasi, Romania.
Faculty of Medicine-Nursing, University of Medicine and Pharmacy Grigore T Popa Iasi, Romania.
Expert Rev Anti Infect Ther. 2021 Dec;19(12):1553-1562. doi: 10.1080/14787210.2021.1933437. Epub 2021 Jun 1.
The SARS-COV-2 pandemic is a worldwide public health problem due to the large medical burden and limited number of therapies available. Corticosteroids have a rather unclear efficacy in viral non-SARS-COV-2 pneumonias and therefore their use is not universally recommended. In SARS-COV-2 pneumonia however, it is expected that they can reduce the deleterious consequences of the virus-related systemic inflammation.
a MEDLINE search covering the period 1995-2020 was completed to identify relevant papers. SARS-COV-2 pathogenesis is very complex and is represented by the interplay of many cytokine-driven inflammation pathways. Its most severe form so called cytokine storm, is an exaggerate reaction of the host infected by the virus rapidly resulting in multiple organ dysfunction (MODS). Corticosteroids have the potential to blunt the inflammation response in such patients, but their efficacy is not the same for all patients. Further on the certainties and uncertainties regarding the efficacy of this therapy in SARS-COV-2 pneumonia are discussed.
In patients with severe SARS-COV-2 pneumonia, corticosteroids can be efficacious, but it is still not clear if they can be safely used in patients with comorbid cardiovascular disease or how the optimal duration of therapy can be established.
由于医疗负担重，治疗方法有限，SARS-CoV-2 大流行是一个全球性的公共卫生问题。皮质类固醇在病毒性非 SARS-CoV-2 性肺炎中的疗效相当不明确，因此不普遍推荐使用。然而，在 SARS-CoV-2 性肺炎中，预计它们可以减轻与病毒相关的全身炎症的有害后果。
完成了对 1995 年至 2020 年期间 MEDLINE 搜索，以确定相关论文。SARS-CoV-2 的发病机制非常复杂，由许多细胞因子驱动的炎症途径相互作用构成。其最严重的形式即细胞因子风暴，是病毒感染宿主后迅速产生的过度炎症反应，导致多器官功能障碍（MODS）。皮质类固醇有可能减轻此类患者的炎症反应，但并非所有患者的疗效都相同。此外，还讨论了 SARS-CoV-2 肺炎中这种治疗方法的疗效的确定性和不确定性。
在严重的 SARS-CoV-2 性肺炎患者中，皮质类固醇可能有效，但仍不清楚它们是否可以安全用于患有合并心血管疾病的患者，以及如何确定最佳的治疗持续时间。
