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)
Corticosteroids were widely used during the outbreaks of severe acute respiratory syndrome (SARS)-CoV1 and Middle East respiratory syndrome (MERS)-CoV,2 and are being used in patients with 2019-nCoV in addition to other therapeutics.3
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.4
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