中美新型冠状病毒感染治疗指导性文件中药物治疗方案比较

Comparison of Drug Treatment Schemes in Coronavirus Disease 2019 Treatment Guidance Documents Between China and the United States

目的为新型冠状病毒感染治疗方案的选择提供参考。方法分析2023年3月美国国立卫生研究院(NIH)发布的Coronavirus Disease 2019(COVID-19)Treatment Guidelines(简称《NIH指南》)和我国国家卫生健康委员会发布的《新型冠状病毒感染诊疗方案(试行第十版)》(简称《诊疗方案》),比较其治疗药物和不同人群治疗方案的异同。结果《诊疗方案》《NIH指南》治疗原则均为早期抗病毒治疗、后期免疫治疗及相应的器官支持治疗。治疗药物方面,《NIH指南》推荐3个抗病毒药物[瑞德西韦、奈玛特韦片/利托那韦片组合包装(Paxlovid)和莫诺拉韦];3类免疫治疗药物[皮质类固醇、白细胞介素6(IL-6)抑制剂和Janus激酶(JAK)抑制剂];《诊疗方案》推荐6个抗病毒方案(阿兹夫定、Paxlovid、莫诺拉韦、单克隆抗体、静注新型冠状病毒感染人免疫球蛋白和康复者恢复期血浆),2类治疗药物(皮质类固醇和IL-6抑制剂托珠单抗),强调传统中医中药治疗。《诊疗方案》在治疗方案的描述上过于简略,仅根据病情的严重程度给出了可供选择的药物,但《NIH指南》提供了具体的优选方案、替代方案和联合治疗方案。结论《诊疗方案》《NIH指南》在治疗药物和不同人群治疗方案上均存在较大差异。建议持续推进新型冠状病毒感染治疗药物的临床研究,细化临床治疗方案,同时关注儿童、孕妇、乳母等特殊人群的药物研究。

Objective To provide a reference for the selection of treatment schemes for coronavirus disease 2019(COVID-19).Methods The COVID-19 Treatment Guidelines issued by the NIH[referred to as the National Institutes of Health(NIH)Guidelines]in March 2023 and the COVID-19 Diagnosis and Treatment Plans(Tenth Edition)issued by the National Health Commission of China(referred to as the Diagnosis and Treatment Plan)were analyzed to compare the similarities and differences between their treatment drugs and treatment plans for different populations.Results The treatment principles of the Diagnosis and Treatment Plan and the NIH Guidelines were giving antiviral treatment in the early stage,and giving immunotherapy and corresponding organ support treatment in the late stage.In terms of treatment drugs,the NIH Guidelines recommend three antiviral drugs[remdesivir,Nirmatrelvir Tablets/Ritonavir Tablets Co-Packaged(paxlovid)and monupiravir],and three types of immunotherapy drugs[corticosteroids,interleukin-6(IL-6)inhibitors,and Janus kinase(JAK)inhibitors].The Diagnosis and Treatment Plan recommended six antiviral regimens(azvudine,paxlovid,molnupiravir,monoclonal antibodies,Human COVID-19 Immunoglobulin for Intravenous Injection,and convalescent plasma),and two types of therapeutic drugs(corticosteroids and IL-6 inhibitor Tocilizumab),emphasizing traditional Chinese medicine treatment.The Diagnosis and Treatment Plan was too brief in describing the treatment plan,only providing alternative drugs based on the severity of the condition,while the NIH Guidelines provided specific preferred plans,alternative plans,and combined treatment plans.Conclusion The Diagnosis and Treatment Plan and NIH Guidelines have significant differences in treatment drugs and treatment plans for different populations.It is recommended to continue promoting clinical research on COVID-19 treatment drugs,refining clinical treatment plans,and paying attention to drug research for special populations such as children,pregnant women,and breastfeeding women.