NEJM:Covid-19住院患者地塞米松疗效分析

2021-02-25 MedSci原创 MedSci原创

在接受有创机械通气或吸氧治疗的住院Covid-19患者中,使用地塞米松可降低其28天死亡率,但在没有呼吸支持的患者中,则不然。

2019新冠肺炎(Covid-19)与弥漫性肺损伤有关。糖皮质激素可能会调节炎症介导的肺损伤,从而降低呼吸衰竭和死亡的几率。

近日,顶级医学期刊NEJM上发表了一篇研究文章,在这项开放性对照试验中,研究人员比较了住院治疗的Covid-19患者可能接受的治疗方案。研究人员随机分配患者接受口服或静脉注射地塞米松(每天一次,剂量为6 mg),最长10天,或仅接受常规治疗。该研究的主要结局为28天死亡率。研究人员报告了该评估的最终结果。

该研究共有2104例患者被分配接受地塞米松治疗,4321例接受常规治疗。总体而言,地塞米松组中的482例患者(22.9%)和常规治疗组中的1110例患者(25.7%)在随机分组后28天内死亡(年龄校正的比值比为0.83;95%置信区间[CI]为0.75至0.93;P<0.001)。死亡率的比例和绝对组间差异根据患者在随机分组时所接受的呼吸支持水平而有很大差异。在接受有创机械通气的患者中,地塞米松组的死亡率低于常规治疗组(29.3% vs. 41.4%;比值比为0.64;95%CI为0.51至0.81),在没有进行有创机械通气仅吸氧的患者中也是如此(23.3% vs. 26.2%;比值比为0.82;95%CI为0.72至0.94),但在未接受呼吸支持的患者则不存在这种现象(17.8% vs. 14.0%;比值比为1.19;95%CI为0.92至1.55)。

由此可见,在接受有创机械通气或吸氧治疗的住院Covid-19患者中,使用地塞米松可降低其28天死亡率,但在没有呼吸支持的患者中,则不然
 
原始出处:
 
The RECOVERY Collaborative Group,et al.Dexamethasone in Hospitalized Patients with Covid-19.NEJM.2021.https://www.nejm.org/doi/full/10.1056/NEJMoa2021436

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  2. [GetPortalCommentsPageByObjectIdResponse(id=1647299, encodeId=abe8164e299ae, content=<a href='/topic/show?id=e9bae04003f' target=_blank style='color:#2F92EE;'>#疗效分析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70400, encryptionId=e9bae04003f, topicName=疗效分析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=219323401160, createdName=rebeccajiejie, createdTime=Sun Mar 21 23:09:38 CST 2021, time=2021-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=927092, encodeId=1ec992e092d9, content=<a href='/topic/show?id=a04e4135027' target=_blank style='color:#2F92EE;'>#地塞米松#</a>对<a href='/topic/show?id=f52851329b' target=_blank style='color:#2F92EE;'>#Covid-19#</a>,确定是有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=261, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=41350, encryptionId=a04e4135027, topicName=地塞米松), TopicDto(id=5132, encryptionId=f52851329b, topicName=Covid-19)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=健康达人, createdTime=Thu Feb 25 13:39:44 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032819, encodeId=cebf103281931, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 25 12:09:38 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035582, encodeId=d4b9103558230, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 25 12:09:38 CST 2021, time=2021-02-25, status=1, ipAttribution=)]
    2021-02-25 健康达人

    #地塞米松##Covid-19#,确定是有效

    1

    展开1条回复
  3. [GetPortalCommentsPageByObjectIdResponse(id=1647299, encodeId=abe8164e299ae, content=<a href='/topic/show?id=e9bae04003f' target=_blank style='color:#2F92EE;'>#疗效分析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70400, encryptionId=e9bae04003f, topicName=疗效分析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=219323401160, createdName=rebeccajiejie, createdTime=Sun Mar 21 23:09:38 CST 2021, time=2021-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=927092, encodeId=1ec992e092d9, content=<a href='/topic/show?id=a04e4135027' target=_blank style='color:#2F92EE;'>#地塞米松#</a>对<a href='/topic/show?id=f52851329b' target=_blank style='color:#2F92EE;'>#Covid-19#</a>,确定是有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=261, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=41350, encryptionId=a04e4135027, topicName=地塞米松), TopicDto(id=5132, encryptionId=f52851329b, topicName=Covid-19)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=健康达人, createdTime=Thu Feb 25 13:39:44 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032819, encodeId=cebf103281931, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 25 12:09:38 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035582, encodeId=d4b9103558230, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 25 12:09:38 CST 2021, time=2021-02-25, status=1, ipAttribution=)]
    2021-02-25 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1647299, encodeId=abe8164e299ae, content=<a href='/topic/show?id=e9bae04003f' target=_blank style='color:#2F92EE;'>#疗效分析#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70400, encryptionId=e9bae04003f, topicName=疗效分析)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=219323401160, createdName=rebeccajiejie, createdTime=Sun Mar 21 23:09:38 CST 2021, time=2021-03-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=927092, encodeId=1ec992e092d9, content=<a href='/topic/show?id=a04e4135027' target=_blank style='color:#2F92EE;'>#地塞米松#</a>对<a href='/topic/show?id=f52851329b' target=_blank style='color:#2F92EE;'>#Covid-19#</a>,确定是有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=261, replyNumber=1, topicName=null, topicId=null, topicList=[TopicDto(id=41350, encryptionId=a04e4135027, topicName=地塞米松), TopicDto(id=5132, encryptionId=f52851329b, topicName=Covid-19)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=健康达人, createdTime=Thu Feb 25 13:39:44 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032819, encodeId=cebf103281931, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=48, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Thu Feb 25 12:09:38 CST 2021, time=2021-02-25, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035582, encodeId=d4b9103558230, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Feb 25 12:09:38 CST 2021, time=2021-02-25, status=1, ipAttribution=)]
    2021-02-25 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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