针对 COVID-19 患者的肺炎靶向洛匹那韦/利托那韦治疗：一项早期回顾性单中心观察研究。
Pneumonia-targeted lopinavir/ritonavir-based treatment for patients with COVID-19: an early-period retrospective single center observational study.
机构信息
Department of Physical Medicine and Rehabilitation, Seoul Medical Center, Seoul, Republic of Korea.
Department of Surgery, Seoul Medical Center, Seoul, Republic of Korea.
出版信息
BMC Infect Dis. 2021 Sep 14;21(1):952. doi: 10.1186/s12879-021-06588-5.
BACKGROUND
Robust evidenced treatment strategy for Coronavirus disease 2019 (COVID-19) has not been established yet. Early, targeted, comprehensive management approach can be essential.
METHODS
A lopinavir/ritonavir (LPV/r)-based antiviral treatment was administered to the patients with computed tomography (CT)-documented pneumonia. Medical records of patients with COVID-19, previously discharged or hospitalized for ≥ 21 days at the Seoul Medical Center from January 29 to April 15, 2020 were reviewed to analyze clinical and virological outcomes. Patients were divided into two groups (PCR-Negative conversion group vs. Non-negative conversion group and requiring oxygen group vs. Non-requiring oxygen group).
RESULTS
In total, 136 patients with a mean age of 41.8 ± 18.2 years were included with median 3-day delay of hospitalization after illness. Thirteen (9.56%) were initially asymptomatic, and 5 (3.67%) were persistently asymptomatic. Eighty-five (62.5%) had CT-documented pneumonia, 94% of whom received LPV/r treatments. A total of 53 patients (38.97%) had negative polymerase chain reaction (PCR) results within 28 days. Eight (9.4%) out of 85 pneumonic patients received oxygen supplementation. Patients with initial lower respiratory symptoms showed significant delay in PCR negative conversion (> 28 days) (odds ratio [OR] 0.166; 95% confidence interval [CI] 0.067-0.477; P < 0.001). However, antiviral treatment for pneumonic patients was significantly related with early conversion within 28 days (OR 3.049; 95% CI 1.128-8.243; P = 0.028). Increasing age increased the likelihood of oxygen supplementation requirement in the pneumonic patient group (OR 1.108; 95% CI 1.021-1.202; P = 0.014).
CONCLUSIONS
Early, pneumonia targeted LPV/r-based antiviral therapy resulted in a significantly higher probability of negative conversion of PCR within 28 days compared to symptomatic treatment.
背景
目前尚未建立针对 2019 年冠状病毒病（COVID-19）的稳健循证治疗策略。早期、靶向、全面的管理方法可能至关重要。
方法
对 CT 确诊为肺炎的患者给予洛匹那韦/利托那韦（LPV/r）为基础的抗病毒治疗。回顾 2020 年 1 月 29 日至 4 月 15 日在首尔医疗中心住院治疗≥21 天的 COVID-19 患者的病历，分析临床和病毒学结果。患者分为两组（PCR 转阴组与非转阴组、需氧组与非需氧组）。
结果
共纳入 136 例患者，平均年龄 41.8±18.2 岁，发病后中位住院时间为 3 天。13 例（9.56%）患者最初无症状，5 例（3.67%）患者持续无症状。85 例（62.5%）患者有 CT 确诊的肺炎，94%的患者接受 LPV/r 治疗。28 天内有 53 例（38.97%）患者的聚合酶链反应（PCR）结果为阴性。85 例肺炎患者中有 8 例（9.4%）接受了氧疗。初始有下呼吸道症状的患者 PCR 转阴时间明显延迟（>28 天）（比值比[OR]0.166；95%置信区间[CI]0.067-0.477；P<0.001）。然而，肺炎患者的抗病毒治疗与 28 天内早期转阴显著相关（OR 3.049；95%CI 1.128-8.243；P=0.028）。肺炎患者年龄增加会增加需氧的可能性（OR 1.108；95%CI 1.021-1.202；P=0.014）。
结论
与对症治疗相比，早期针对肺炎的 LPV/r 为基础的抗病毒治疗可显著提高 28 天内 PCR 转阴的可能性。
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