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对于部分新冠肺炎患者,延长类固醇治疗可能有益。

A prolonged steroid therapy may be beneficial in some patients after the COVID-19 pneumonia.

作者信息

Kostorz-Nosal Sabina, Jastrzębski Dariusz, Chyra Michał, Kubicki Piotr, Zieliński Michał, Ziora Dariusz

机构信息

Department of Lung Diseases and Tuberculosis, Faculty of Medical Sciences in Zabrze, Silesia Medical University in Katowice, Poland.

Pulmonology Department, Silesia Medical University in Katowice, Poland.

出版信息

Eur Clin Respir J. 2021 Jun 24;8(1):1945186. doi: 10.1080/20018525.2021.1945186.

Abstract

: This report introduces two cases presenting absorption of considerable radiological changes in the course of the coronavirus pneumonia in patients treated with prolonged oral steroids.: The first case concerns a male receiving steroids only during hospitalisation in the Infectious Disease Hospital. After discharge, the patient experienced increasing dyspnoea resulting in hospitalisation in our Department of Lung Diseases. HRCT revealed progression of a bilateral, middle, and basal ground-glass opacity when compared to the examination performed at the early stage of the disease. The supplementary oxygen therapy and steroids were administered, followed by extended prednisone consumption up to 2 months after discharge. Follow-up HRCT revealed an almost complete absorption of the ground-glass opacity. The second case concerns a male treated with steroids only during hospitalisation in the Infectious Disease Hospital. Chest CT revealed widespread bilateral ground-glass opacities with consolidations. After discharge with no treatment, he suffered from severe dyspnoea and exercise intolerance, resulting in hospitalisation on the 7 day of home stay. Since then, a continued steroid treatment was administered resulting in a clinical, spirometric, and radiological improvement.: Based on these observations, patients after the COVID-pneumonia may derive benefits from a prolonged steroid treatment. Therefore, this class of medications should be considered in SARS-CoV-2 patients, especially in patients with persistent radiological changes and dyspnoea requiring the supplementary oxygen therapy. However, randomised controlled trials are required to establish guidelines for the steroid treatment in this group of patients.

摘要

本报告介绍了两例在接受长期口服类固醇治疗的冠状病毒肺炎患者病程中出现显著放射学改变吸收的病例。第一例涉及一名仅在传染病医院住院期间接受类固醇治疗的男性。出院后,患者呼吸困难加重,导致入住我院肺病科。与疾病早期进行的检查相比,高分辨率CT(HRCT)显示双侧、中叶和基底磨玻璃影进展。给予补充氧疗和类固醇治疗,出院后泼尼松服用时间延长至2个月。随访HRCT显示磨玻璃影几乎完全吸收。第二例涉及一名仅在传染病医院住院期间接受类固醇治疗的男性。胸部CT显示双侧广泛磨玻璃影并伴有实变。出院后未接受治疗,他出现严重呼吸困难和运动不耐受,在家中停留7天时住院。此后,持续给予类固醇治疗,临床、肺功能和放射学均有改善。基于这些观察结果,新冠肺炎后的患者可能从长期类固醇治疗中获益。因此,对于新冠病毒2型患者,尤其是有持续放射学改变且呼吸困难需要补充氧疗的患者,应考虑使用这类药物。然而,需要进行随机对照试验来制定该组患者类固醇治疗的指南。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a730/8231404/41365d266ee6/ZECR_A_1945186_F0001_OC.jpg

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