大剂量脉冲甲泼尼龙与地塞米松标准疗法治疗重症和危重症 COVID-19 肺炎：来自马来西亚单中心回顾性经验的疗效评估。

High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia.

机构信息

University Malaya Medical Center, Division of Respiratory Medicine, Kuala Lumpur, Malaysia.

University Malaya Medical Center, Department of Internal Medicine, Kuala Lumpur, Malaysia.

出版信息

Med J Malaysia. 2024 Jan;79(1):15-20.

PMID:38287752

Abstract

INTRODUCTION

The use of dexamethasone (DXM) has been associated with decreased mortality in the patients with hypoxemia during the coronavirus disease-2019 (COVID-19) pandemic, while the outcomes with methylprednisolone (MTP) have been mixed. This real-life study aimed to evaluate the outcomes of patients with severe respiratory failure due to COVID-19 who were treated with high doses of MTP.

MATERIALS AND METHODS

This retrospective cohort study enrolled hospitalised patients between May 2021 and August 2021, aged 18 years and above, with severe respiratory failure defined by a ratio of oxygen saturation to fraction of inspired oxygen (SF ratio) of less than 235. The treatment protocol involved administering high-dose MTP for 3 days, followed by DXM, and the outcomes were compared with those of patients who received DXM alone (total treatment duration of 10 days for both groups).

RESULTS

A total of 99 patients were enrolled, with 79 (79.8%) receiving pulse MTP therapy and 20 (20.2%) being treated with DXM only. The SF ratio significantly improved from a mean of 144.49 (±45.16) at baseline to 208 (±85.19) at 72 hours (p < 0.05), with a mean difference of 63.51 (p < 0.001) in patients who received ≤750 mg of MTP. Additionally, in patients who received >750 mg of MTP, the SF ratio improved from a baseline mean of 130.39 (±34.53) to 208.44 (±86.61) at 72 hours (p < 0.05), with a mean difference of 78.05 (p = 0.001). In contrast, patients who received DXM only demonstrated an SF ratio of 132.85 (±44.1) at baseline, which changed minimally to 133.35 (±44.4) at 72 hours (p = 0.33), with a mean difference of 0.50 (p = 0.972). The incidence of nosocomial infection was higher in the MTP group compared with the DXM group (40.5% vs. 35%, p = 0.653), with a relative risk of 1.16 (95% CI: 0.60-2.23).

CONCLUSION

MTP did not demonstrate a significant reduction in intubation or intensive care unit admissions. Although a high dose of MTP improved gas exchange in patients with severe and critical COVID-19, it did not provide an overall mortality benefit compared to standard treatment.

摘要

介绍

在 2019 年冠状病毒病（COVID-19）大流行期间，使用地塞米松（DXM）与低氧血症患者的死亡率降低有关，而甲泼尼龙（MTP）的结果则喜忧参半。本真实世界研究旨在评估因 COVID-19 导致严重呼吸衰竭并接受高剂量 MTP 治疗的患者的结局。

材料和方法

本回顾性队列研究纳入了 2021 年 5 月至 2021 年 8 月期间住院的年龄在 18 岁及以上的患者，严重呼吸衰竭的定义为氧饱和度与吸入氧分数（SF 比）比值低于 235。治疗方案包括 3 天的高剂量 MTP 治疗，然后是 DXM，将其与仅接受 DXM 的患者的结局进行比较（两组的总治疗时间均为 10 天）。

结果

共纳入 99 例患者，其中 79 例（79.8%）接受脉冲 MTP 治疗，20 例（20.2%）仅接受 DXM 治疗。SF 比值从基线时的 144.49（±45.16）显著改善至 72 小时时的 208（±85.19）（p<0.05），接受≤750mg MTP 的患者平均差异为 63.51（p<0.001）。此外，接受>750mg MTP 的患者 SF 比值从基线时的 130.39（±34.53）改善至 72 小时时的 208.44（±86.61）（p<0.05），平均差异为 78.05（p=0.001）。相比之下，仅接受 DXM 的患者基线时的 SF 比值为 132.85（±44.1），72 小时时变化极小，为 133.35（±44.4）（p=0.33），平均差异为 0.50（p=0.972）。MTP 组的院内感染发生率高于 DXM 组（40.5% vs. 35%，p=0.653），相对风险为 1.16（95%CI：0.60-2.23）。