地塞米松在冠状病毒治疗中的应用

Application of Dexamethasone in the Treatment of Coronavirus

目的探讨地塞米松在冠状病毒治疗中的应用特点,为在新型冠状病毒肺炎(COVID-19)中合理使用提供参考。方法检索中国知网、万方和Pubmed数据库,收集截至2020年6月18日发表的关于应用地塞米松治疗冠状病毒的文献,采用描述性评价和分析方式进行总结分析。结果共纳入5篇文献。地塞米松能够将使用呼吸机治疗的新型冠状病毒肺炎重症患者死亡率降低1/3,比仅接受氧气治疗的患者死亡率降低1/5。地塞米松可以减轻猪呼吸道冠状病毒(PRCV)感染早期肺部病变,但加重感染中晚期症状;白细胞介素(IL)-6呈现先下降后上升趋势,而干扰素(IFN)-α、IFN-γ、IL-4、IFN-γCSC、CD+3、CD+4、CD+8在感染中晚期出现下降。地塞米松使经过SARS冠状病毒N蛋白处理的大鼠IL-6、IL^-10、TGF-β1水平出现显著下降。地塞米松不能抑制经过SARS病毒处理的THP-1细胞产生RANTES。结论地塞米松能够降低COVID-19患者死亡率,应当明确地塞米松的起始治疗时机、使用疗程以及使用注意事项。

Objective To explore the characteristics of dexamethasone in coronavirus treatment,and to provide a reference for the rational use of dexamethasone in coronavirus disease 2019(COVID-19).Methods Literatures of dexamethasone in the treatment of coronavirus which was published until June 18,2020 were retrieved from CNKI,Wanfang database and Pubmed,and analyzed by descriptive evaluation method.Results Five articles were included.Dexamethasone could reduce the mortality rate of by one third inpatients with severe COVID-19 using ventilator,and the mortality rate of the patients receiving only oxygen therapy decreased by 1/5.Dexamethasone could reduce the early stage of pulmonary lesions of porcine respiratory coronavirus(PRCV)infection,but aggravate the symptoms in the middle and late stage of infection.The level of IL-6 decreased first and then increased,while IFN-α,IFN-γ,IL-4,IFN-γCSC,CD+3,CD+4,CD+8 decreased in the middle and late stages of infection.Dexamethasone significantly reduced the levels of IL-6,IL^-10,and TGF-β1 in rats infected with SARS coronavirus N protein.Dexamethasone could not inhibit the production of RANTES in SARS-CoV-infected THP-1 cells.Conclusion Dexamethasone could reduce the mortality rate of patients with COVID-19.The timing of the initial therapy of dexamethasone,the duration of therapy and precautions for the use should be clear.