糖皮质激素治疗新型冠状病毒肺炎的有效性和安全性分析

目的探讨糖皮质激素治疗新型冠状病毒肺炎(简称新冠肺炎)的有效性和安全性,为新冠肺炎的诊治和药学监护提供参考。方法查阅文献,总结既往糖皮质激素在社区获得性重症肺炎、严重急性呼吸综合征(SARS)、中东呼吸综合征(MERS)等肺部疾病治疗中的应用情况,结合新冠肺炎最新诊疗方案并参考一线用药经验,总结糖皮质激素治疗的临床疗效和使用注意事项。结果与结论糖皮质激素辅助性治疗新冠肺炎的风险与获益尚无定论。新冠肺炎的诊治过程中可在参考国内外指南、文献并结合一线救治经验的基础上短疗程、小剂量使用糖皮质激素,但应严格把握用药指征,加强药学监护。建议开展大样本、多中心、随机对照试验研究其风险与获益,研究导致新冠肺炎进展的关键炎性因子,并阐明患者的个体差异,为针对性选用/开发抗炎药物或单克隆抗体药物奠定理论基础。

Efficacy and Safety of Corticosteroids in the Treatment of the Coronavirus Disease 2019

Objective To investigate the efficacy and safety of corticosteroids in the treatment of the coronavirus disease 2019( COVID-19),in order to provide reference for its diagnosis,treatment and pharmaceutical care. Methods The clinical efficacy and precautions of corticosteroids in the treatment of the COVID-19 were summarized by reviewing the literature of glucocorticoids in the treatment of community-acquired severe pneumonia,the severe acute respiratory syndrome( SARS),the Middle East respiratory syndrome( MERS) and other lung diseases in accordance with the latest guideline and medication experience for the COVID-19.Results and Conclusion The risk and benefit of corticosteroids in the adjuvant treatment of the COVID-19 are still uncertain. We can use corticosteroids in the treatment of the COVID-19 with the small dose for short course according to the latest guidelines,literature and medication experience at home and abroad. However,we should strictly grasp the indications of drug use and strengthen pharmaceutical care. It is suggested to carry out a large sample,multicenter,randomized controlled trial to study the risk and benefit of corticosteroids in the treatment of the COVID-19. It is also suggested that the key inflammatory factors in the pathophysiology of the COVID-19 should be studied and the individual differences of patients need to be clarified. The evidence will lay a theoretical foundation for the selection/development of anti-inflammatory drugs or monoclonal antibody drugs.