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地塞米松治疗Covid-19患者疗效分析
作者:小柯机器人 发布时间:2020/7/22 15:30:58

RECOVERY协作小组研究了地塞米松治疗Covid-19的效果。相关论文于2020年7月17日发表在《新英格兰医学杂志》上。

Covid-19与弥漫性肺损伤有关。糖皮质激素可调节炎症介导的肺损伤,从而降低发展为呼吸衰竭和死亡的风险。

在这项对照、开放标签试验中,研究组比较了Covid-19住院患者的一系列疗法,将患者随机分组,其中2104名接受口服或静脉注射地塞米松治疗,持续10天;4321名接受常规治疗。主要结局为28天死亡率。

总体而言,地塞米松组中有482例患者(22.9%)在随机分组后的28天内死亡,显著低于常规治疗组(1110例患者,25.7%)。根据随机分组时患者接受的呼吸支持水平,组间的死亡率比例和绝对差异有很大区别。

接受有创机械通气的患者中,地塞米松组的死亡率为29.3%,显著低于常规治疗组(41.4%);在非有创机械通气供氧的患者中,地塞米松组的死亡率为23.3%,显著低于常规治疗组(26.2%);但在未接受呼吸支持的患者中,两组间死亡率分别为17.8%和14.0%,差异不显著。

总之,对于Covid-19住院患者,在接受有创机械通气或仅接受供氧治疗的患者中,使用地塞米松可有效降低28天死亡率,但在无呼吸支持的患者中并无差异。

附:英文原文

Title: Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report

Author: The RECOVERY Collaborative Group

Issue&Volume: 2020-07-17

Abstract: BACKGROUND

Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death.

METHODS

In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the preliminary results of this comparison.

RESULTS

A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55).

CONCLUSIONS

In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.

DOI: 10.1056/NEJMoa2021436

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2021436

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home