類固醇於SARS及MERS流行時曾被廣泛用於治療,但目前WHO在2019-CoV感染個案的臨床指引中,則不建議使用。下表整理了冠狀病毒及類似流行中,使用類固醇治療的臨床結果:

 類固醇治療結果備註
MERS-CoV呼吸道病毒RNA清除延遲Adjusted HR 0.4 (95% CI=0.2-0.7)
SARS-CoV血液病毒RNA清除延遲有顯著差異但無說明差多少
SARS-CoV副作用:精神方面疾病與高累積劑量有關,hydrocortisone劑量10,975 mg vs. 6,780 mg
SARS-CoV副作用:糖尿病95名患者中,有33名發展出類固醇導致之糖尿病。
SARS-CoV副作用:存活者中出現失血性壞死40名接受類固醇治療並存活之個案,有12位出現失血性壞死,30位骨壞死。
Influenza死亡率增加一項整合10個研究,6,548名患者的meta-analysis顯示,死亡比為1.75(95% CI=1.3-2.4)
RSV在兒童無臨床效益一項包括600名兒童的隨機分配臨床試驗,305名接受類固醇治療,研究結果沒有顯示療效。

目前證據顯示,2019-nCoV感染者無法從類固醇治療中獲益,反而可能在治療中受到傷害,因此不建議對2019-nCoV肺損傷患者使用類固醇。

(財團法人國家衛生研究院莊淑鈞博士摘要整理)

The 2019 novel coronavirus (2019-nCoV) outbreak is a major challenge for clinicians. The clinical course of patients remains to be fully characterised, little data are available that describe the disease pathogenesis, and no pharmacological therapies of proven efficacy yet exist.

Corticosteroids were widely used during the outbreaks of severe acute respiratory syndrome (SARS)-CoV and Middle East respiratory syndrome (MERS)-CoV, and are being used in patients with 2019-nCoV in addition to other therapeutics.

 

 However, current interim guidance from WHO on clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected (released Jan 28, 2020) advises against the use of corticosteroids unless indicated for another reason.

 

Understanding the evidence for harm or benefit from corticosteroids in 2019-nCoV is of immediate clinical importance. Here we discuss the clinical outcomes of corticosteroid use in coronavirus and similar outbreaks (table).

Author:Clark D Russell, Jonathan E Millar, J Kenneth Baillie
原文連結:https://www.thelancet.com/lancet/article/corticosteroid-treatment