新型冠状病毒肺炎药物治疗的思考

Pharmacotherapeutics for the new coronavirus pneumonia

新型冠状病毒肺炎(new coronavirus pneumonia,NCP)正在中国引起严重疫情,截至发稿之日,全国确诊人数已逾4万.冠状病毒已经在全世界范围内引起数次疫情,但此次疫情的来势之迅猛及传染性之强前所未有.我们对引起此次疫情的病原体——2019新型冠状病毒知之甚少,目前在国际上发表的临床研究文章或为单中心研究,或为回顾性分析.我们结合在新冠肺炎一线的救治体会及相关发表的研究成果,给大家分享新冠肺炎的治疗经验.抗病毒药物方面,目前仍无特效药物,利巴韦林和干扰素联合用药由于其治疗中东呼吸综合征(MERS)有效,仍被我国新冠肺炎诊疗方案推荐;洛匹那韦/利托那韦和瑞德西韦的疗效有待随机对照临床试验(randomized controlled trial,RCT)评价;糖皮质激素的短期应用(1~2 mg·kg-1·d-1,3~5 d)被我国诊疗方案推荐,但仍需RCT进一步证实;本次新冠肺炎合并细菌感染较少,应当避免盲目使用抗菌药物,尤其避免联用广谱抗菌药物.

The new coronavirus pneumonia(NCP),also named as COVID-19 by WHO on Feb 112020,is now causing a severe public health emergency in China since.The number of diagnosed cases is more than 40,000 until the submission of this manuscript.Coronavirus has caused several epidemic situations world widely,but the present contagious disease caused by 2019 new coronavirus is unprecedentedly fulminating.The published cohorts of 2019 new coronavirus(n-Cov)are single-center studies,or retrospective studies.We here share the therapeutic experiences of NCP treatment with literature review.Combination of Ribavirin and interferon-αis recommended by the 5th edition National Health Commission′s Regimen(Revised Edition)because of the effect on Middle East respiratory syndrome(MERS),and the effectiveness of Lopinavir/Ritonavir and Remdisivir needs to be confirmed by randomized controlled trial(RCT),given the situation of no specific antivirus drug on NCP is unavailable.Systemic glucocorticosteroid is recommended as a short term use(1~2 mg·kg-1·d-1,3~5 d)by the 5th edition National Health Commission′s Regimen(Revised Edition)yet RCTs are expected to confirm the effectiveness.Inappropriate application of antibiotics should be avoided,especially the combination of broad-spectrum antibiotics,for the NCP is not often complicated with bacterial infection.