托珠单抗联合糖皮质激素在重型/危重型2019冠状病毒病中的应用效果

Application Effect of Tocilizumab Combined with Glucocorticoid in Severe/Critical Corona Virus Disease 2019

目的:探讨托珠单抗联合糖皮质激素治疗重型/危重型2019冠状病毒病患者的效果及安全性。方法:回顾性分析2020年2月—2023年3月同济医院光谷院区、宁波市医疗中心李惠利医院收治的17例重型/危重型2019冠状病毒病患者。给予患者托珠单抗(8 mg/kg静脉滴注)联合甲泼尼龙(40~80 mg/d静脉滴注)治疗。在治疗前及治疗后对患者临床症状进行记录,同时检测患者血常规、C反应蛋白(CRP)、白细胞介素-6(IL-6),并记录患者不良反应发生情况和治疗转归。结果:治疗后患者发热占比[41.2%(7/17)]低于治疗前[100%(17/17)],差异有统计学意义(P<0.05)。治疗后患者CRP水平较治疗前显著下降,差异有统计学意义(P<0.05)。16例患者治疗后好转,其中4例(23.5%)属于重型,12例(70.6%)属于危重型。所有患者均未出现不良反应。结论:托珠单抗联合糖皮质激素治疗可显著缓解重型/危重型2019冠状病毒病患者发热症状,且无明显的不良反应,转归良好,提示托珠单抗联合糖皮质激素在2019冠状病毒病治疗中具有良好的治疗潜能及安全性。

Objective:To explore the efficacy and safety of Tocilizumab combined with glucocorticoid in patients with severe/critical corona virus disease 2019.Method:A total of 17 patients with severe/critical corona virus disease 2019 admitted to Optical Valley Branch of Tongji Hospital and Ningbo Medical Center Lihuili Hospital from February 2020 to March 2023 were analyzed retrospectively.Patients were given Tocilizumab(8 mg/kg intravenously)combined with Methylprednisolone(40-80 mg/d intravenously).The clinical symptoms of patients were recorded before and after treatment.At the same time,the blood routine,C reactive protein(CRP)and interleukin-6(IL-6)were detected.The occurrence of adverse reactions and treatment outcomes were recorded.Result:The proportion of fever after treatment[41.2%(7/17)]was lower than that before treatment[100%(17/17)],the difference was statistically significant(P<0.05).The level of CRP after treatment was significantly decreased compared with that before treatment,the difference was statistically significant(P<0.05).16 patients improved after treatment,of which 4 cases(23.5%)were severe and 12 cases(70.6%)were critical.No adverse reactions occurred in all patients.Conclusion:Tocilizumab combined with glucocorticoid treatment can significantly alleviate the fever symptoms of patients with severe/critical corona virus disease 2019,and there is no obvious adverse reaction,and the outcome is good,suggesting that Tocilizumab combined with glucocorticoid has good therapeutic potential and safety in the treatment of corona virus disease 2019.