Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Department of Medicine, Respiratory Unit, Kuala Lumpur, Malaysia.
Universiti Kebangsaan Malaysia, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Department of Radiology, Kuala Lumpur, Malaysia.
Med J Malaysia. 2024 May;79(3):296-305.
The efficacy of long-course corticosteroid therapy in treating COVID-19-related diffuse interstitial lung abnormalities (DILA) needs to be better understood. We aimed to investigate the benefits of 12-week corticosteroid treatment in COVID-19-related DILA by evaluating computed tomography (CT) lung severity scores.
This retrospective, single-centre observational study included patients aged 18 years or older admitted with moderate to severe COVID-19 pneumonia who received 12 weeks of oral prednisolone between January 2021 and December 2021. We recorded clinical parameters, baseline CT scores and post-treatment, modified Medical Research Council (mMRC) dyspnoea scale and pulmonary function tests.
A total of 330 patients were analysed. The mean (standard deviation, SD) age was 54.6 (14.2) years, and 43% were females. Three-point nine per cent (3.9%) require noninvasive ventilation (NIV), while 14.6% require mechanical ventilation (MV). On follow-up at 12 weeks, the CT patterns showed improvement in ground-glass opacities, perilobular density and consolidation. There was an improvement in the mean (SD) CT score before and after prednisolone therapy, with values of 17.3 (5.3) and 8.6 (5.5), respectively (p<0.001). The median mMRC was 1 (IQR 0-1), and 98.8% had a radiological response. The common side effects of prednisolone therapy were weight gain (13.9%), hyperglycaemia (1.8%) and cushingoid habitus (0.6%).
A 12-week treatment with prednisolone showed significant improvement in CT scores with minimal residual dyspnoea and was relatively safe. Longer duration of steroids may be beneficial in moderate to severe COVID-19- related DILA.
长疗程皮质类固醇治疗 COVID-19 相关弥漫性间质肺异常（DILA）的疗效需要更好地了解。我们旨在通过评估计算机断层扫描（CT）肺严重程度评分来研究 COVID-19 相关 DILA 中 12 周皮质类固醇治疗的益处。
这是一项回顾性、单中心观察性研究，纳入了 2021 年 1 月至 2021 年 12 月期间因中度至重度 COVID-19 肺炎入院并接受 12 周口服泼尼松龙治疗的 18 岁及以上患者。我们记录了临床参数、基线 CT 评分以及治疗后、改良的医学研究委员会（mMRC）呼吸困难量表和肺功能检查。
共分析了 330 例患者。患者的平均（标准差）年龄为 54.6（14.2）岁，43%为女性。3.9%需要无创通气（NIV），14.6%需要机械通气（MV）。在 12 周随访时，CT 模式显示磨玻璃影、小叶旁密度和实变的改善。泼尼松龙治疗前后 CT 评分的平均值（标准差）分别为 17.3（5.3）和 8.6（5.5）（p<0.001）。中位 mMRC 为 1（IQR 0-1），98.8%有影像学反应。泼尼松龙治疗的常见副作用包括体重增加（13.9%）、高血糖（1.8%）和库欣样体型（0.6%）。
泼尼松龙治疗 12 周可显著改善 CT 评分，呼吸困难最小残留，且相对安全。在中重度 COVID-19 相关 DILA 中，延长皮质类固醇的疗程可能有益。
