Retrospective analysis of low and medium⁃dose glucocorticoids in the treatment of severe COVID⁃19
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摘要:
目的：回顾性分析中小剂量糖皮质激素在重症新型冠状病毒肺炎（corona virus disease-2019，COVID-19）患者治疗中的作用。方法：回顾性分析2020年2月15日—3月20日南京医科大学附属逸夫医院援黄石医疗队在黄石市中医医院收治的95例重症COVID-19患者的临床资料，根据是否使用糖皮质激素分为对照组（常规治疗，33例）和激素治疗组（常规治疗联合糖皮质激素治疗，62例），比较两组的实验室检查结果、临床症状缓解时间、28 d死亡率、重症向危重症转变率、住院天数、炎症指标、氧合指数改善、影像学改变以及不良反应的发生情况。结果：一般临床资料中，激素治疗组的淋巴细胞计数及单核细胞计数明显低于对照组（P < 0.05），其余基线临床资料两组无明显差异。与对照组相比，激素治疗组临床症状缓解时间明显缩短［9.50（5.00，14.50）d vs. 16.00（5.00，21.00）d，P＜0.001］，重症/危重症转换率明显下降［12.90% vs. 33.33%，P=0.029］，住院天数明显缩短［20.00（16.00，22.00）d vs. 24.00（20.50，26.50）d，P=0.002］，28 d死亡率未见明显升高［6.45% vs. 9.09%，P=0.691］，氧合指数恢复明显增快，炎症因子C反应蛋白、白介素-6下降幅度明显增大，影像学吸收速度明显增快，两组间不良反应无明显差别。结论：中小剂量糖皮质激素能显著缩短重症COVID-19患者临床症状缓解时间，改善氧合，促进肺部病变吸收，且没有明显不良反应，在重症COVID-19治疗过程中可以短疗程使用。
Abstract:
Objective：This study aims to retrospectively analyze the effects of low and medium-dose glucocorticoids in treating of severe corona virus disease-2019 （COVID-19）. Methods：A retrospective analysis of the clinical data of 95 patients with severe COVID-19 admitted to the Huangshi Hospital of Traditional Chinese Medicine assisted by the Huangshi Medical Team of the Affiliated Sir Run Run Hospital of Nanjing Medical University from Feb，15th，2020 to Mar，20th，2020 was conducted. Control group（conventional treatment，33 cases）or hormone treatment group（conventional treatment combined glucocorticoid，62 cases）were divided according to whether using glucocorticoids or not. Laboratory test results，time of clinical symptoms relieved，the 28-day mortality rate，severe to critical convention rate，hospitalization days，inflammation index，improvement of oxygenation index，imaging changes and the occurrence of adverse reactions were compared between the two groups. Results：In general clinical data，the lymphocyte count and monocyte count from the hormone treatment group were significantly lower than that from the control group（P < 0.05），and there was no significant difference in the remaining baseline clinical data between the two groups. Compared with the control group，the clinical symptom relief time from hormone treatment group was significantly shorter［9.50（5.00，14.50）d vs. 16.00（5.00，21.00）d，P ＜ 0.001］，the conversion rate of severe to critical illness was significantly reduced［12.90% vs. 33.33%，P=0.029］，and the time of hospital stay was significantly shortened［20.00（16.00，22.00）d vs. 24.00（20.50，26.50）d，P=0.002］，the 28-day mortality rate was not increased［6.45% vs. 9.09%，P=0.691］. The oxygenation index recovery increased，the inflammatory factors of C-reactive protein and IL-6 decreased，and the imaging absorption speed increased significantly. There was no significant difference in adverse reactions between the two groups. Conclusion：Low and medium-dose glucocorticoids can significantly shorten the clinical symptom relief time of patients with severe COVID-19，improve oxygenation，promote lung lesion absorption，and have not obvious adverse reactions. It can be used in a short course during the treatment of severe COVID-19.
