糖皮质激素治疗新型冠状病毒肺炎的疗效观察

Clinical observation of glucocorticoids in the management of COVID-19

目的探讨糖皮质激素治疗普通型、重症和危重症新型冠状病毒肺炎(COVID-19)的临床效果。方法回顾性分析248例COVID-19确诊患者。评估患者严重程度为普通型、重症和危重症。根据患者住院期间是否接受糖皮质激素治疗将患者分为非激素治疗组和激素治疗组。非激素组予以吸氧、抗病毒等治疗,激素组加用甲泼尼龙短期治疗。统计各组患者出院病死率、住院时间、首发症状至出院时间,评估COVID-19患者经激素治疗后的临床改善情况;采用ELISA法检测S-IgG、S-IgM、S-RBD-IgG、N-IgG和N-IgM抗体动态变化评估激素治疗对免疫功能的影响。结果非激素治疗组与激素治疗组相比,普通型和重症患者出院病死率差异无统计学意义;与非激素治疗组相比,激素治疗组的危重症患者出院病死率升高(68%vs 40%,P<0.05)。与非激素治疗组相比,激素治疗组普通型患者住院时间较长[22(17-28)d vs 16(12-22)d],差异有统计学意义(P<0.001)。激素治疗组和非激素治疗组患者的S-IgG、S-RBD和N-IgG抗体水平呈逐渐上升趋势,S-IgM和N-IgM抗体呈逐渐下降趋势,两组间比较,差异无统计学意义。结论短期糖皮质激素治疗并不能改善COVID-19患者的病死率和住院时间,对患者免疫功能无显著影响。

Objective To investigate the clinical improvement of glucocorticoid in the treatment of mild,severe,and critical cases of coronavirus disease 2019(COVID-19).Methods A retrospective study included 248 patients with confirmed COVID-19.The severity of the patient was assessed as mild,severe,and critical.Patients were divided into non-hormonal group and hormonal group according to whether they received glucocorticoid therapy during their hospitalization.The non-hormone group was treated with oxygen support and antiviral therapy,and the hormone group was treated with methylprednisolone for a short term.The discharge mortality rate,hospitalization time,and time from symptom onset to discharge were analyzed.The dynamic changes of S-IgG,S-IgM,S-RBD-IgG,N-IgG,and N-IgM antibodies were detected by ELISA.Results There was no difference in discharge mortality between mild,severe patients in the glucocorticoid therapy group and non-glucocorticoid treatment group,while the mortality was higher in critical patients treated with glucocorticoid(68%vs 40%,P<0.05).The hospitalization time in mild patients receiving glucocorticoid therapy was higher than that in the non-glucocorticoid treatment group[22(17-28)d vs 16(12-22)d],and the difference was statistically significant(P<0.05).The S-IgG,S-RBD and N-IgG antibodies showed a gradually increasing trend,while the S-IgM and N-IgM antibodies showed a gradually decreasing trend,and there was no statistical significance between the two groups.Conclusion Short-term glucocorticoid therapy can not improve the mortality rate and clinical outcome,and has no significant effect on the immune function of patients with COVID-19.