糖皮质激素对 COVID-19 肺炎胸部高分辨率 CT 特征的疗效。
Effectiveness of corticosteroids on chest high-resolution computed tomography features of COVID-19 pneumonia.
机构信息
Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli' and A.O.R.N. Ospedali dei Colli, Via Leonardo Bianchi, 80131 Naples, Italy.
Department of Advanced Medical and Surgical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy.
出版信息
Ther Adv Respir Dis. 2021 Jan-Dec;15:17534666211042533. doi: 10.1177/17534666211042533.
OBJECTIVE
The aim of our study was to assess the effect of a short-term treatment with low-moderate corticosteroid (CS) doses by both a quantitative and qualitative assessment of chest HRCT of COVID-19 pneumonia.
METHODS
CORTICOVID is a single-center, cross-sectional, retrospective study involving severe/critical COVID-19 patients with mild/moderate ARDS. Lung total severity score was obtained according to Chung and colleagues. Moreover, the relative percentages of lung total severity score by ground glass opacities, consolidations, crazy paving, and linear bands were computed. Chest HRCT scores, P/F ratio, and laboratory parameters were evaluated before (pre-CS) and 7-10 days after (post-CS) methylprednisolone of 0.5-0.8 mg/kg/day.
FINDINGS
A total of 34 severe/critical COVID-19 patients were included in the study, of which 17 received Standard of Care (SoC) and 17 CS therapy in add-on. CS treatment disclosed a significant decrease in HRCT total severity score [median = 6 (IQR: 5-7.5) 10 (IQR: 9-13) in SoC, < 0.001], as well in single consolidations [median = 0.33 (IQR: 0-0.92) 6.73 (IQR: 2.49-8.03) in SoC, < 0.001] and crazy paving scores [mean = 0.19 (SD = 0.53) 1.79 (SD = 2.71) in SoC, = 0.010], along with a significant increase in linear bands [mean = 2.56 (SD = 1.65) 0.97 (SD = 1.30) in SoC, = 0.006]. GGO score instead did not significantly differ at the end of treatment between the two groups. Most post-CS GGO, however, derived from previous consolidations and crazy paving [median = 1.5 (0.35-3.81) 2 (1.25-3.8) pre-CS; = 0.579], while pre-CS GGO significantly decreased after methylprednisolone therapy [median = 0.66 (0.05-1.33) 1.5 (0.35-3.81) pre-CS; = 0.004]. CS therapy further determined a significant improvement in P/F levels [median P/F = 310 (IQR: 235.5-370) 136 (IQR: 98.5-211.75) in SoC; < 0.001], and a significant increase in white blood cells, lymphocytes, and neutrophils absolute values.
CONCLUSION
The improvement of all chest HRCT findings further supports the role of CS adjunctive therapy in severe/critical COVID-19 pneumonia.
目的
本研究旨在通过对 COVID-19 肺炎的胸部高分辨率 CT（HRCT）进行定量和定性评估，来评估短期使用低-中剂量皮质类固醇（CS）治疗的效果。
方法
CORTICOVID 是一项单中心、横断面、回顾性研究，涉及患有轻度/中度 ARDS 的严重/危重症 COVID-19 患者。根据 Chung 等人的方法计算肺总严重程度评分。此外，计算了磨玻璃影、实变、铺路石征和线性条带的肺总严重程度评分的相对百分比。在甲基泼尼松龙 0.5-0.8mg/kg/天治疗前（CS 前）和 7-10 天后（CS 后）评估胸部 HRCT 评分、P/F 比值和实验室参数。
结果
共纳入 34 例严重/危重症 COVID-19 患者，其中 17 例接受标准治疗（SoC），17 例加用 CS 治疗。CS 治疗后 HRCT 总严重程度评分明显下降[中位数=6（IQR：5-7.5） 10（IQR：9-13）在 SoC 中， <0.001]，单个实变[中位数=0.33（IQR：0-0.92） 6.73（IQR：2.49-8.03）在 SoC 中， <0.001]和铺路石征评分[平均值=0.19（SD=0.53） 1.79（SD=2.71）在 SoC 中， =0.010]也明显下降，而线性条带评分[平均值=2.56（SD=1.65） 0.97（SD=1.30）在 SoC 中， =0.006]则显著增加。然而，两组之间在治疗结束时 GGO 评分并没有显著差异。然而，大多数 CS 后的 GGO 是由先前的实变和铺路石征演变而来[中位数=1.5（0.35-3.81） 2（1.25-3.8）在 CS 前； =0.579]，而甲基泼尼松龙治疗后 CS 前的 GGO 显著减少[中位数=0.66（0.05-1.33） 1.5（0.35-3.81）在 CS 前； =0.004]。CS 治疗进一步显著改善了 P/F 水平[中位数 P/F=310（IQR：235.5-370） 136（IQR：98.5-211.75）在 SoC 中； <0.001]，并显著增加了白细胞、淋巴细胞和中性粒细胞的绝对值。
结论
所有胸部 HRCT 发现的改善进一步支持了 CS 辅助治疗在严重/危重症 COVID-19 肺炎中的作用。
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