皮质类固醇对由SARA-CoV-2引起的肺部疾病进行治疗
V. T. Ivaschkin,
O. Yu. Zolnikova,
A. A. Svistunov,
N. L. Dzhakhaya,
N. D. Potskhverashvili,
N. I. Kokina,
E. R. Buklis,
T. V. Roshchina,
I. I. Komkova,
M. Yu. Nadinskaia https://doi.org/10.47093/2218-7332.2020.11.2.19-28
摘要
研究目的：
研究皮质类固醇用于治疗SARS-CoV-2所致肺损伤的有效性。
研究对象和方法：
该回顾性研究对象为存在肺部CT改变，且接受了低分子肝素治疗的SARS-CoV-2确诊感染者。第一组有56名患者，在入院后的8-10日内，在基础治疗之外，每日接受4-12mg地塞米松；第二组（对照组）是30名未接受地塞米松的患者。在治疗第8-10天，研究人员对上述患者实验室数据与入院数据进行了比较。使用卡普兰-梅尔（Kaplan-Meier）法对临床死亡率进行了研究；为了对死亡的发生进行预测，采用了逻辑回归法。
结论：
住院8-10日后，仅在第一组数据中观察到CT下肺组织病变的体积（p＝0.0027）血纤维蛋白原浓度（p＝0.001）具有统计学意义的显著减小。在两组数据中均可见C-反应蛋白浓度具有统计学意义的显著降低。第二组患者对氧疗的需求相对更高：第二组中的26例患者（87%）相对于第一组中的36例患者（64%）（p＝0.028）。第一组的临床死亡率为3.6%，在第二组中为13.3%（p＝0.177）。在住院第18-28天之间，第一组患者存活率存在增加趋势（Mantel-Cox测试，p＝0.095）。逻辑回归方程包含：年龄（p＝0.012），入院时CT病变百分比（p＝0.020）和归属于地塞米松组（p＝0.080）。
总结：
在存在肺部CT改变且接受了低分子肝素治疗的SARS-CoV-2感染患者中，自入院起连续数日内，按每日4-12mg的剂量给予地塞米松可促进患者肺部CT在治疗第8-10日产生好转迹象，并降低临床死亡率。
关于作者
V. T. Ivaschkin
Sechenov First Moscow State Medical University (Sechenov University)
俄罗斯联邦
俄罗斯联邦
Vladimir T. Ivaschkin, MD, PhD, DMSc, Professor, Academician of the RAS, Head of the Department of Internal Diseases Propedeutics; Director of V. Vasilenko Clinic of Internal Diseases Propedeutics, Gastroenterology and Hepatology, University Clinical Hospital No. 2
8/2, Trubetskaya str., Moscow, 119991
O. Yu. Zolnikova
Sechenov First Moscow State Medical University (Sechenov University)
俄罗斯联邦
俄罗斯联邦
Oxana Yu. Zolnikova, MD, PhD, Associate Professor, Department of Internal Diseases Propedeutics
8/2, Trubetskaya str., Moscow, 119991
+7 (916) 391-69-56
A. A. Svistunov
Sechenov First Moscow State Medical University (Sechenov University)
俄罗斯联邦
俄罗斯联邦
Andrey A. Svistunov, MD, PhD, DMSc, Professor, Corresponding Member of the RAS, First Vice-rector
8/2, Trubetskaya str., Moscow, 119991
N. L. Dzhakhaya
Sechenov First Moscow State Medical University (Sechenov University)
俄罗斯联邦
俄罗斯联邦
Natiya L. Dzhakhaya, MD, PhD, Associate Professor, Department of Internal Diseases Propedeutics
8/2, Trubetskaya str., Moscow, 119991
N. D. Potskhverashvili
Sechenov First Moscow State Medical University (Sechenov University)
俄罗斯联邦
俄罗斯联邦
Nino D. Potskhverashvili, MD, PhD, doctor, Pulmonology Department, V. Vasilenko Clinic for Internal Diseases Propedeutics, Gastroenterology and Hepatology, University Clinical Hospital No. 2
8/2, Trubetskaya str., Moscow, 119991
N. I. Kokina
Sechenov First Moscow State Medical University (Sechenov University)
俄罗斯联邦
俄罗斯联邦
Nataliya I. Kokina, MD, PhD, Head of the Pulmonology Department, V. Vasilenko Clinic for Internal Diseases Propedeutics, Gastroenterology and Hepatology, University Clinical Hospital No. 2; Associate Professor, Department of Internal Diseases Propedeutics
8/2, Trubetskaya str., Moscow, 119991
E. R. Buklis
Sechenov First Moscow State Medical University (Sechenov University)
俄罗斯联邦
俄罗斯联邦
Elvira R. Buklis, MD, PhD, doctor, Pulmonology Department, V. Vasilenko Clinic for Internal Diseases Propedeutics, Gastroenterology and Hepatology, University Clinical Hospital No. 2
8/2, Trubetskaya str., Moscow, 119991
T. V. Roshchina
Sechenov First Moscow State Medical University (Sechenov University)
俄罗斯联邦
俄罗斯联邦
Tatyana V. Roshchina, MD, PhD, doctor, Pulmonology Department, of V. Vasilenko Clinic for Internal Diseases Propedeutics, Gastroenterology and Hepatology, University Clinical Hospital No. 2
8/2, Trubetskaya str., Moscow, 119991
I. I. Komkova
Sechenov First Moscow State Medical University (Sechenov University)
俄罗斯联邦
俄罗斯联邦
Inna I. Komkova, MD, PhD, doctor, Pulmonology Department, of V. Vasilenko Clinic for Internal Diseases Propedeutics, Gastroenterology and Hepatology, University Clinical Hospital No. 2
8/2, Trubetskaya str., Moscow, 119991
M. Yu. Nadinskaia
Sechenov First Moscow State Medical University (Sechenov University)
俄罗斯联邦
俄罗斯联邦
Maria Yu. Nadinskaia, MD, PhD, Associate Professor, Department of Internal Diseases Propedeutics
8/2, Trubetskaya str., Moscow, 119991
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