224例新型冠状病毒肺炎抗病毒疗效的回顾性分析

Retrospective analysis of the antiviral efficacy in 224 patients with coronavirus disease 2019

目的评价不同抗病毒方案对治疗新型冠状病毒肺炎(COVID-19)的临床疗效。方法回顾性分析2020年1月24日—3月7日重庆市公共卫生医疗救治中心收治的确诊为COVID-19患者的临床资料。比较不同抗病毒治疗方案在临床疗效及安全性方面是否存在差异。结果224例COVID-19住院患者纳入研究,男107例(47.8%),总平均年龄(46.3±16.2)岁,从发病到入院的中位数时间为5(1~21)d。共有8种不同抗病毒治疗方案用于抗新型冠状病毒治疗,各方案间(α干扰素,α干扰素+洛匹那韦/利托那韦,α干扰素+利巴韦林,α干扰素+洛匹那韦/利托那韦+利巴韦林,其他方案)在呼吸道标本病毒核酸转阴时间、14 d内病毒核酸转阴率、入院后病情进展为重症比例及总体不良反应发生率方面差异均无统计学意义(P>0.05),接受3种抗病毒药物治疗者消化道不良反应发生率明显高于接受1~2种抗病毒药物治疗者(P<0.05)。结论不同抗病毒治疗方案疗效之间未见显著差异,未发现在α干扰素雾化吸入基础上联合洛匹那韦/利托那韦或/和利巴韦林能缩短病毒核酸转阴时间或缓解病情。

Objective To evaluate the efficacy and safety of different antiviral drugs in patients with coronavirus disease 2019(COVID-19).Methods Clinical data of confirmed COVID-19 patients were collected in Chongqing Public Health Medical Center from January 24,2020 to March 7,2020.Antiviral drugs were compared in terms of efficacy and safety.Results A total of 224 cases were collected.About half(47.8%,107/224)of the patients were men.The mean age of the patients was(46.3±16.2)years.The median(range)time from onset to admission was 5(1-21)days.Overall,8 different antiviral regimens[interferon alpha(IFNα);IFNα+lopinavir/ritonavir;IFNα+ribavirin;IFNα+lopinavir/ritonavir+ribavirin and other regimens]were used in the treatment of COVID-19 patients.The time to virus nucleic acid conversion,14-day negative conversion rate,proportion of patients becoming critically ill after admission,and overall incidence of adverse reactions did not show significant difference between the antiviral combinations(P>0.05).However,the patients treated with triplet antiviral regimen had higher incidence of nausea/vomiting and diarrhea.Conclusions Different antiviral regimens do not show significant difference in clinical efficacy in COVID-19 patients.There is no evidence to support the efficacy of lopinavir/ritonavir and ribavirin add-on to INFαaerosol inhalation in reducing the time to virus nucleic acid conversion or mitigating the disease.