Page 82 - 南京医科大学学报自然科学版

南京医科大学学报（自然科学版） 第41卷第11期
·1644 · Journal of Nanjing Medical University（Natural Sciences） 2021年11月

·临床研究·

中小剂量糖皮质激素治疗重症COVID⁃19患者的回顾性分析

陈晓林，吴明景，舒 磊，石 磊，冯旰珠
南京医科大学附属逸夫医院呼吸科，江苏 南京 211166

［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。
［关键词］ 糖皮质激素；重症新型冠状病毒肺炎；回顾性分析
［中图分类号］ R511.7 ［文献标志码］ A ［文章编号］ 1007⁃4368（2021）11⁃1644⁃06
doi：10.7655/NYDXBNS20211113

Retrospective analysis of low and medium⁃dose glucocorticoids in the treatment of severe
COVID⁃19

CHEN Xiaolin，WU Mingjing，SHU Lei，SHI Lei，FENG Ganzhu
Department of Respiratory Medicine，the Affiliated Sir Run Run Hospital of Nanjing Medical University，Nanjing
211166，China

［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
th
th
Run Run Hospital of Nanjing Medical University from Feb，15 ，2020 to Mar，20 ，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