背景

新型冠状病毒（Corona virus disease 2019，COVID-19）肺炎是一种由SARS-CoV-2感染引起的肺部炎症，有潜在的引起免疫系统过度应答的风险，进而发展为重症肺炎，对人类健康和生命构成威胁。糖皮质激素是抑制炎症反应的有效药物，它可以显著抑制肺部炎症的免疫反应，减轻多器官衰竭的症状，是很多病毒感染引起重症肺部疾病的有效治疗药物之一。然而，目前对于糖皮质激素治疗新型冠状病毒肺炎的启动时机尚无共识。

目的

本研究旨在探讨启用糖皮质激素治疗重型和危重型新型冠状病毒肺炎患者的时机对于患者结局的影响。

方法

本研究收集了2022年12月至2023年1月在北京协和医院急诊科及发热门诊就诊的新型冠状病毒肺炎患者，依照中国《新型冠状病毒肺炎诊疗方案（试行第九版）》选择重型和危重型患者，记录基本资料、临床表现、实验室检查结果、基线氧合状况、氧疗支持、机械通气及预后等。本研究是一项回顾性队列研究，采用T检验和单因素比例风险分析研究，探讨启用糖皮质激素治疗时间对患者预后的影响。

结果

研究共纳入100例患者，将患者根据应用糖皮质激素时间距离出现首次症状时间的中位数（9天）进行分组，分为早期加用激素治疗组（≤9天，n=51）和晚期加用激素治疗组（> 9天，n=49）两组。与早期接受糖皮质激素治疗的新型冠状病毒疾病肺炎患者相比，晚期接受糖皮质激素治疗的患者入住 ICU 的比例较高（2.0% vs 10.0%，P= 0.011），HR为6.282（95%CI 1.300, 30.358），住院时间较长（9天 vs 12.5天，P = 0.006），住院生存率较低（44 vs 33例，P =0.03），恢复较慢（17 vs 22天，P < 0.001），康复时间≤21天的HR为0.227（95%CI 0.081, 0.634）。在Logistic单因素比例风险分析中也观察到显著差异。

结论

早期应用糖皮质激素治疗可显著改善重型/危重型新型冠状病毒肺炎患者的临床预后，促进康复，具有重要的临床意义。

Background

The coronavirus disease 2019 (COVID-19) pneumonia is a pulmonary inflammation condition caused by SARS-CoV-2 infection, which has been the potential to progress to severe pneumonia by the trigger systemic inflammatory response, posing a threat to human health and life. Due to their anti-inflammatory effects, corticosteroids could significantly inhibit immune responses of pulmonary inflammatory, relieve symptoms of multi-organ failure, always played a vital role in the treatment of pulmonary diseases caused by many viral infections. However, there is currently no consensus on the specific use of corticosteroids in the treatment of COVID-19 pneumonia, particularly regarding the timing of administration.

Purpose

This study aims to provide recommendations on the optimal timing of corticosteroid therapy based on the characteristics of severe and critical COVID-19 pneumonia and clinical treatment experience.

Methods

This study included COVID-19 pneumonia between December 2022 and January 2023 who attended the emergency department and fever clinic. The diagnosis of severe and critical COVID-19 pneumonia patients was according to China’s Ninth Edition of the Diagnosis and Treatment Plan for COVID-19 Pneumonia. Basic data, clinical features, laboratory values, baseline oxygenation condition, oxygen treatment conditions, mechanical ventilation were recorded. T test and univariate proportional hazard analysis were employed to investigate the opportunity of corticosteroids therapy in relation to patients’ prognosis.

Results

Summarized the demographics and other baseline characteristics of the 100 enrolled patients, all patients were stratified according to the median time from the first symptoms to the start of corticosteroids treatment (9 days), the patients were divided into two groups: early corticosteroid (≤9days, n=51) and late corticosteroid (＞9days, n=49). Compared to COVID-19 pneumonia patients treated with corticosteroids in the early phase, those who received late-phase corticosteroid therapy had a higher proportion of intensive care unit (ICU) admission (2 vs. 10 cases, p=0.011), HR 6.282 (95%CI: 1.300, 30.358), longer hospital stay (9 vs. 12.5 days, p=0.006), lower in-hospital survival rate (44 vs. 33 cases, p=0.03), and slower recovery (17 vs. 22 days, p<0.001), time to recovery≤21d HR 0.227 (95%CI 0.081, 0.634). A significant difference was also observed in logistic univariate proportional hazard analysis.

Conclusions

The early administration of corticosteroid therapy has been shown to significantly improve the prognosis of severe and critical COVID-19 pneumonia patients, promoting recovery with significant clinical significance.