应对新型冠状病毒肺炎,我们能从SARS中得到哪些借鉴

目前对于新型冠状病毒肺炎(简称：新冠肺炎)的病程机制和治疗方法的选择等方面仍有许多未知之处。由于2019-nCoV和SARS-CoV之间的高度相似性,从严重急性呼吸综合征(severe acute respiratory syndrome,SARS)中获得的一些知识经验,尤其是患者肺部病毒复制和免疫应答的时间规律和病程的演变特征,或许能对我们深入了解和应对新冠肺炎提供重要的借鉴。     

洛匹那韦/利托那韦在新型冠状病毒肺炎合并肿瘤患者中的药物相互作用监护

新型冠状病毒肺炎治疗药物洛匹那韦/利托那韦(LPV/r)是多种细胞色素P 450(CYP 450)酶的抑制剂,又是多种CYP 450酶底物,此外还是P-糖蛋白的抑制剂、葡萄糖醛酸转移酶诱导剂,与很多抗肿瘤药物存在药物相互作用。药品说明书仅列举了少数抗肿瘤药物与LPV/r的相互作用,提供参考信息严重不足。本文系统总结了抗肿瘤药物及常用辅助药物和LPV/r的相互作用及处理建议。     

新型冠状病毒肺炎与糖尿病：我们何去何从？

新型冠状病毒肺炎(简称新冠肺炎,又称COVID-19)是危害全球的流行性疾病,其与糖尿病的关系研究甚少。糖尿病是新冠肺炎最常见的并发症之一,糖尿病患者免疫功能障碍、促炎性细胞因子环境、血管紧张素转换酶2表达降低及低血糖反应等与新冠肺炎的不良预后密切相关。而严重急性呼吸综合征病毒2(SARS-CoV-2)直接损伤胰岛β细...     

洛匹那韦利托那韦和阿比多尔用于治疗新型冠状病毒肺炎的有效性研究

目的评价洛匹那韦利托那韦和阿比多尔对治疗新型冠状病毒肺炎的有效性。方法回顾性分析2020年1月20日至2月6日上海市公共卫生临床中心收治的134例新型冠状病毒肺炎患者的临床资料。134例患者均接受重组人干扰素α2b喷雾治疗及对症支持治疗,其中52例患者口服抗病毒药物洛匹那韦利托那韦,34例患者口服抗病毒药物阿比多尔,48例患者不服用任何抗病毒药物。比较3组患者的治疗效果。统计学分析采用卡方检验。结果134例患者中,男69例(51.5%),女65例(48.5%),年龄范围为35~62岁,平均年龄为48岁。阿比多尔组和洛匹那韦利托那韦组患者体温恢复正常的中位时间均为6 d,对照组为4 d,3组间差异无统计学意义(χ^2=2.37,P=0.31)。3组患者呼吸道标本病毒核酸转阴中位时间均为治疗后7 d,洛匹那韦利托那韦组第7天病毒核酸转阴率为71.8%(28/39),阿比多尔组为82.6%(19/23),对照组为77.1%(27/35),差异无统计学意义(χ^2=0.46,P=0.79)。洛匹那韦利托那韦组[42.3%(22/52)]、阿比多尔组[35.3%(12/34)]和对照组[52.1%(25/48)]患者治疗后第7天影像学仍为进展表现(χ^2=2.38,P=0.30)。洛匹那韦利托那韦组不良反应生率为17.3%(9/52),阿比多尔组为8.8%(3/34),对照组为8.3%(4/48),3组间差异无统计学意义(χ^2=2.33,P=0.33)。结论未发现洛匹那韦利托那韦和阿比多尔具有改善新型冠状病毒肺炎患者症状或缩短呼吸道标本病毒核酸转阴时间的作用,其有效性仍有待进一步临床研究确认。     

肥胖与病毒感染性疾病的关系及新型冠状病毒肺炎防治思路探讨

新型冠状病毒肺炎(COVID-19)是由严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引起的呼吸系统传染病,具有传染性强、潜伏期长的特点.目前,COVID-19已经扩散至全球多个国家,且感染人数仍在不断攀升.对阳性患者进行隔离和减少人群聚集是COVID-19的主要预防办法,然而针对COVID-19的特效药仍在探索...     

新型冠状病毒肺炎患者4S呼吸康复指引

2019新型冠状病毒(2019-nCoV)感染的肺炎具有高度传染性,本文结合4S(simple,safe,satisfy,save)呼吸康复内容和2019新型冠状病毒肺炎的诊治标准,对2019-nCoV所致的肺炎患者提供可行的呼吸康复指引.     

三种抗病毒方案对普通型新型冠状病毒肺炎治疗效果的比较

目的:分析并比较3种不同治疗新型冠状病毒肺炎方案的疗效及不良反应,为普通型新型冠状病毒肺炎的治疗提供一定参考。方法:回顾性分析2020年2月3日至3月7日湖北省十堰市某新型冠状病毒肺炎指定救治点诊治的84例普通型新型冠状病毒肺炎患者的临床、影像、检验学相关资料。按治疗过程中所使用的抗病毒方案分为3组,其中使用α-干扰素...     

冠状病毒肺炎的流行趋势

目的通过对历史上发生的3次冠状病毒肺炎[严重急性呼吸综合征(SARS)、中东呼吸综合征(MERS)、新型冠状病毒肺炎(COVID-19)]流行数据的深入分析,探讨冠状病毒的传播特征与流行规律,探索疫情防控的关键节点,从而为公共卫生决策提供依据。方法针对3种冠状病毒的累计感染例数、新增感染例数、累计死亡例数与时间的关系进行描述统计与时间趋势分析,并按疫情的地区分布进行COVID-19与SARS亚组分析,进而比较不同地区疫情流行的异同点。采用SPSS 17.0对数据进行分析。结果3种冠状病毒肺炎中,COVID-19的传染速率最大,病死率最低(2.96%);MERS的传染速率最低,但病死率最高(30.49%)。COVID-19与SARS的流行规律相似,累计感染病例均是短期内迅速增长,累计感染曲线呈S型。而MERS主要以散发病例为主。结论冠状病毒的传染性与致死性存在着一定的负相关关系,即传染性越强致死性越低。冠状病毒的防控关键点是疫情早期切断传播途径可有效控制疫情扩散。     

氯喹药理特点及用于新型冠状病毒肺炎治疗的建议

2019年底,我国湖北省武汉市出现了新型冠状病毒肺炎疫情,随后在全国扩散并成为全球大流行。由于尚无针对新型冠状病毒的特效治疗药物和疫苗,我国新型冠状病毒感染救治临床专家团队在救治新型冠状病毒感染患者的同时,积极研究和筛选有效抗病毒治疗药物,发现一种古老的抗疟药--氯喹有一定抗新型冠状病毒效果,随后纳入我国新型冠状病毒肺炎诊疗方案。目前,临床应用的是氯喹衍生物磷酸氯喹和硫酸羟氯喹,这两种药物虽药理机制相近,但其治疗对象、疗效和不良反应均存在一定差异。本文拟通过对氯喹类药物已有研究和在疟疾临床治疗中的经验总结,为我国临床专家更科学合理地使用氯喹类药物进行新型冠状病毒肺炎治疗提供参考。     

Early prediction model for progression and prognosis of severe patients with coronavirus disease 2019

Coronavirus disease 2019 (COVID-19) has been a rampant worldwide health threat and we aimed to develop a model for early prediction of disease progression.This retrospective study included 124 adult inpatients with COVID-19 who presented with severe illness at admission and had a definite outcome (recovered or progressed to critical illness) during February 2020. Eighty-four patients were used as training cohort and 40 patients as validation cohort. Logistic regression analysis and receiver operating characteristic curve (ROC) analysis were used to develop and evaluate the prognostic prediction model.In the training cohort, the mean age was 63.4 ± 1.5 years, and male patients (48, 57%) were predominant. Forty-three (52%) recovered, and 41 (49%) progressed to critical. Decreased lymphocyte count (LC, odds ratio [OR] = 4.40, P = .026), elevated lactate dehydrogenase levels (LDH, OR = 4.24, P = .030), and high-sensitivity C-reactive protein (hsCRP, OR = 1.01, P = .025) at admission were independently associated with higher odds of deteriorated outcome. Accordingly, we developed a predictive model for disease progression based on the levels of the 3 risk factors (LC, LDH, and hsCRP) with a satisfactory performance in ROC analysis (area under the ROC curve [AUC] = 0.88, P < .001) and the best cut-off value was 0.526 with the sensitivity and specificity of 75.0% and 90.7%, respectively. Then, the model was internally validated by leave-one-out cross-validation with value of AUC 0.85 (P < .001) and externally validated in another validation cohort (26 recovered patients and 14 progressed patients) with AUC 0.84 (P < .001).We identified 3 clinical indicators of risk of progression and developed a severe COVID-19 prognostic prediction model, allowing early identification and intervention of high-risk patients being critically illness.     

新型冠状病毒感染的流行特点与趋势

自2019年12月底以来,湖北省武汉市报告了一组与华南海鲜市场有关的病因不明的肺炎病例,现已经证实该疾病是由新型冠状病毒(2019-nCoV)感染引起的。疫情迅速蔓延,波及全国各地及23个国家,截至2020年2月8日,已造成34 955例感染,725例死亡。本文结合最新的研究成果及SARS和MERS的流行病学研究,就2019-n Co V感染的流行特点作一综述,并对疫情发展趋势和防控策略进行探讨。     

常见慢性疾病与新型冠状病毒肺炎患者重症化风险的系统评价及荟萃分析

目的:探讨合并各种常见慢性疾病与新型冠状病毒肺炎(COVID-19)患者重症化风险的相关性。方法:检索PubMed、Embase、Cochrane等外文数据库,中国知网数据库、万方数据库、中国生物医学文献数据库等中文数据库,以及3个预印文本网站(medRxiv、SSRN和ChinaXiv)中2020年1月24日至3月5日发表的有关重症、非重症COVID-19患者合并慢性疾病的临床和流行病学研究。分析COVID-19患者合并慢性阻塞性肺疾病、糖尿病、高血压、恶性肿瘤、心血管疾病、脑血管疾病、慢性肾脏病和慢性肝脏疾病的患病率,并计算重症患者、非重症患者常见慢性疾病患病率的比值比(odds ratio,OR)和95%可信区间(confidence interval,CI)。采用R 3.6.3软件进行荟萃分析。结果:从2455篇相关文献中筛选纳入19篇文献,共计4792例患者进行分析。COVID-19患者中男性占55.0%(95%CI 40.0%~80.0%),合并慢性疾病的总体患病率为30.4%(95%CI 24.0%~37.0%)。其中最常见的是高血压[16.9%(95%CI 14.0%~20.0%)],其次是糖尿病[8.3%(95%CI 8.0%~9.0%)]。重症COVID-19患者中男性的比例高于非重症患者(64.4%比52.8%,OR=1.49,95%CI 1.08~2.05,Z=4.63,P<0.01)。重症患者合并慢性阻塞性肺疾病、脑血管疾病、糖尿病、慢性肾脏病、高血压、心血管疾病、恶性肿瘤的患病率分别是非重症患者的5.77倍(95%CI 3.80~8.74)、4.47倍(95%CI 2.71~7.38)、3.55倍(95%CI 2.86~4.40)、3.05倍(95%CI 1.76~5.28)、2.82倍(95%CI 1.96~3.97)、2.39倍(95%CI 1.77~3.23)、2.15倍(95%CI 1.27~3.66),两组间差异均有统计学意义(Z=8.37、6.01、11.60、4.20、5.46、5.71、3.12,均P<0.01)。重症患者慢性肝脏疾病的患病率与非重症患者相比差异无统计学意义(OR=1.35,95%CI 0.84~2.17,P=0.11)。结论:伴有慢性疾病的COVID-19患者重症化风险较高,由高到低依次为慢性阻塞性肺疾病、脑血管疾病、糖尿病、慢性肾脏病、高血压、心血管疾病、恶性肿瘤。     

新型冠状病毒肺炎疫情下内镜再处理对消毒效果的影响及不合格因素分析

目的:探讨新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)疫情下内镜再处理对消毒效果的影响及分析灭菌不合格因素。方法:采用数字随机法选取重庆医科大学附属第二医院2019年11月—2020年1月按照《软式内镜清洗消毒技术规范》进行内镜清洗消毒的内镜450条作为对照组,2020年2—4...     

我国境外输入性疟疾防控策略对当前新型冠状病毒肺炎防控工作的启示

目前,我国新型冠状病毒肺炎本地传播已得到有效控制,但境外新型冠状病毒肺炎疫情形势日趋严峻。因此,我国新型冠状病毒肺炎防控工作面临境外输入的新挑战。疟疾曾在我国广泛流行,自2010年启动消除疟疾行动计划后,我国不仅阻断了疟疾本地传播,对每年3000例左右境外输入性疟疾病例的防控也卓有成效。本文通过对当前我国新型冠状病毒肺炎和疟疾疫情形势及流行特征的比较分析,结合我国境外输入性疟疾防控的成功经验,探讨当前新型冠状病毒肺炎疫情防控的策略和措施,为有效应对境外输入、巩固防控成果提供借鉴。     

Predictive model for the development of critical coronavirus disease 2019 and its risk factors among patients in Japan

BackgroundThis study aimed to examine risk factors associated with critical coronavirus disease 19 (COVID-19) and to establish a risk predictive model for Japanese patients.MethodsWe retrospectively assessed adult Japanese patients diagnosed with COVID-19 at the Japanese Red Cross Medical Center, Tokyo, Japan between February 1, 2020 and March 10, 2021. The patients were divided into critical and non-critical groups based on their condition during the clinical courses. Univariate and multivariate logistic regression analyses were performed to investigate the relationship between clinical characteristics and critical illness. Based on the results, we established a predictive model for the development of critical COVID-19.ResultsIn total, 300 patients were enrolled in this study. Among them, 86 were included in the critical group. Analyses revealed that age ≥65 y, hemodialysis, need for O₂ supplementation upon diagnosis, and an initial serum C-reactive protein level of ≥6.5 mg/dL were independently associated with the development of critical COVID-19. Next, a predictive model for the development of critical COVID-19 was created, and this included the following variables: age ≥65 y, male sex, diabetes, hemodialysis, need for O₂ supplementation upon diagnosis, and an initial serum C-reactive protein level of ≥6.5 mg/dL. The area under the receiver operating characteristic curve of the model was 0.86 (95% confidence interval, 0.81–0.90). Using a cutoff score of 12, the positive and negative predictive values of 74.0% and 80.4% were obtained, respectively.ConclusionsUpon diagnosis, the predictive model can be used to identify adult Japanese patients with COVID-19 who will require intensive treatment.     

Lifestyle changes and their impact on glycemic control and weight control in patients with diabetes during the coronavirus disease 2019 pandemic in Japan

Aims/IntroductionThis study aimed to reveal lifestyle changes and their impact on glycemic control and weight control in patients with diabetes during the coronavirus disease 2019 (COVID‐19) pandemic in Japan.Materials and MethodsWe retrospectively analyzed 1,402 outpatients with diabetes at a clinic in Osaka, Japan, who responded to an interview sheet regarding lifestyle changes during the COVID‐19 pandemic between 28 March and 30 May 2020. The association of lifestyle changes with hemoglobin A1c (HbA1c) and weight changes from February to May 2020 was investigated using the linear regression model. We also investigated the association with clinically important change of HbA1c (by ≥0.3%) and bodyweight (by ≥3%), using the cumulative link model.ResultsLeisure time and other outside physical activities were decreased in one‐quarter of patients during the COVID‐19 pandemic, whereas the amount of meals and snacks was decreased and increased in approximately 10%, respectively. The change in leisure time physical activities was inversely associated with HbA1c and weight changes, whereas the quantitative change of meals with the decline in eating out and that of snacks were positively associated with HbA1c and weight changes (all P < 0.05). The quantitative change of meals without the decline in eating out was also positively associated with weight change (P = 0.012). The cumulative link model for clinically important HbA1c and weight change showed broadly similar associations, except for that between snacks and bodyweight (P = 0.15).ConclusionsA considerable number of outpatients with diabetes experienced lifestyle changes during the COVID‐19 pandemic. The lifestyle changes were associated with HbA1c and weight changes.     

Statin and outcomes of coronavirus disease 2019 (COVID-19): A systematic review,meta-analysis,and meta-regression

AimsOne of the comorbidities associated with severe outcome and mortality of COVID-19 is dyslipidemia. Statin is one of the drugs which is most commonly used for the treatment of dyslipidemic patients. This study aims to analyze the association between statin use and composite poor outcomes of COVID-19.Data synthesisWe systematically searched the PubMed and Europe PMC database using specific keywords related to our aims until November 25th, 2020. All articles published on COVID-19 and statin were retrieved. Statistical analysis was done using Review Manager 5.4 and Comprehensive Meta-Analysis 3 software.ResultsA total of 35 studies with a total of 11, 930, 583 patients were included in our analysis. Our meta-analysis showed that statin use did not improve the composite poor outcomes of COVID-19 [OR 1.08 (95% CI 0.86–1.35), p = 0.50, I² = 98%, random-effect modelling]. Meta-regression showed that the association with composite poor outcomes of COVID-19 was influenced by age (p = 0.010), gender (p = 0.045), and cardiovascular disease (p = 0.012). Subgroup analysis showed that the association was weaker in studies with median age ≥60 years-old (OR 0.94) compared to <60 years-old (OR 1.43), and in the prevalence of cardiovascular disease ≥25% (RR 0.94) compared to <25% (RR 1.24).ConclusionStatin use did not improve the composite poor outcomes of COVID-19. Patients with dyslipidemia should continue taking statin drugs despite COVID-19 infection status, given its beneficial effects on cardiovascular outcomes.