Dexamethasone: Puas muaj cov kws tshawb fawb pom muaj kev kho mob rau cov neeg mob hnyav COVID-19?

Tus nqi qis dexamethasone txo qis kev tuag txog li ib feem peb ntawm cov neeg mob hauv tsev kho mob uas muaj teeb meem ua pa hnyav ntawm COVID-19

Cov kws tshawb fawb tau tsis ntseeg txog qhov laj thawj rau kev kho mob ntev corticosteroid hauv Acute Respiratory Distress Syndrome (ARDS) los ntawm Covid-19. Qhov no tau kawm los ntawm Villar et al¹ tsis ntev los no uas cov kws sau ntawv tham txog qhov tsis ntseeg raws li cov pov thawj los ntawm tsuas yog plaub qhov kev tshawb fawb me me uas qhia tias cov neeg mob tsis tau txais txiaj ntsig los ntawm steroid kev kho mob^2,3. Txawm li cas los xij, kev tshawb fawb los ntawm Wuhan, Suav⁴ thiab Itlay⁵ pom zoo siv cov tshuaj steroids rau ARDS tshwm sim los ntawm COVID-19. Tam sim no muaj pov thawj ntxiv tau los ntawm RECOVERY (Randomised Evaluation of COVID-19 thERapY) sim⁶ hauv kev pom zoo ntawm steroids los ntawm kev siv dexamethasone rau kev kho mob ntawm loj heev Cov neeg mob COVID-19 mob nyob rau hauv qhov kev sim ntsuas los ntawm ib pab pawg kws tshawb fawb los ntawm University of Oxford, UK.

Ntau tshaj 11,500 tus neeg mob tau tso npe los ntawm ntau dua 175 lub tsev kho mob NHS hauv tebchaws Askiv los sim ntau yam tshuaj tsis yog tshuaj lom neeg thiab tshuaj lom neeg suav nrog hydroxychloroquine, tshuaj tiv thaiv kab mob thiab Tocilizumab. Qhov kev sim uas tau ua haujlwm txij li lub Peb Hlis 2020 thaum kawg tau pom tus yeej meej ntawm cov tshuaj siv hauv kev tawm tsam COVID-19 thiab qhov ntawd yog dexamethasone. Hydroxychloroquine raug tso tseg vim muaj neeg tuag coob ntxiv thiab teeb meem plawv thaum lwm yam tshuaj tau sim rau COVID-19 ib yam nkaus, txawm hais tias muaj kev ua tau zoo tsawg dua li qhov kev sim rov qab muaj kev txhawj xeeb.

Tag nrho ntawm 2104 tus neeg mob tau randomized tau txais dexamethasone 6 mg ib hnub ib zaug (los ntawm qhov ncauj lossis los ntawm kev txhaj tshuaj intravenously) rau 10 hnub thiab tau muab piv nrog 4321 cov neeg mob uas tsis tau txais cov tshuaj. Ntawm cov neeg mob uas tsis tau txais cov tshuaj, 28-hnub kev tuag yog siab tshaj plaws ntawm cov neeg uas xav tau qhov cua (41%), nruab nrab ntawm cov neeg mob uas xav tau oxygen xwb (25%), thiab qis tshaj ntawm cov neeg uas tsis xav tau kev ua pa. kev cuam tshuam (13%). Dexamethasone txo cov neeg tuag los ntawm 33% hauv cov neeg mob ua pa thiab 20% ntawm lwm cov neeg mob tau txais cov pa oxygen xwb. Txawm li cas los xij, tsis muaj txiaj ntsig ntawm cov neeg mob uas tsis xav tau kev txhawb nqa ua pa.

Cov tshuaj steroidal kuj tau siv hauv lwm cov kev tshawb fawb uas cuam tshuam nrog COVID-19. Hauv kev tshawb fawb luam tawm los ntawm Lu et al⁷, 151 tus neeg mob ntawm 244 tus neeg mob tau muab cov tshuaj tiv thaiv kab mob ua ke nrog rau kev kho mob corticosteroid adjuvant (qhov nruab nrab hydrocortisone-sib npaug ntau npaum li 200 [ntau 100–800] mg / hnub). Nyob rau hauv txoj kev tshawb no, tsawg ciaj sia taus (30%) tau pom nyob rau hauv 28 hnub nrog cov neeg mob tau txais xws li ib tug ntau npaum li cas ntawm steroids piv rau cov neeg uas tsis (80%).

Dexamethasone twb tau siv los txo qhov mob ntawm ntau yam mob. Nyob rau hauv rooj plaub ntawm COVID-19, dexamethasone zoo li txo qhov mob tshwm sim los ntawm cytokine cua daj cua dub uas tshwm sim los ntawm qhov tshwm sim ntawm tus kab mob COVID-19. Yog li, cov tshuaj no zoo li yog qhov txuj ci tseem ceeb kho rau cov neeg mob uas muaj kev pheej hmoo siab COVID-19 uas yuav tsum tau pw hauv tsev kho mob. Kev kho mob ntawm dexamethasone yog mus txog 10 hnub thiab raug nqi 5 phaus ib tus neeg mob. Cov tshuaj no muaj thoob plaws ntiaj teb thiab tuaj yeem siv los cawm txoj sia ntawm cov neeg mob COVID-19 mus tom ntej.

Kev tshawb fawb ntxiv nrog dexamethasone yuav tsum tau ua nyob thoob plaws ntau lub tebchaws thiab haiv neeg thoob ntiaj teb txhawm rau tsim kom muaj txiaj ntsig zoo rau COVID-19.

Puas yog cov kws tshawb fawb thaum kawg pom tus nqi qis, yooj yim muaj, kho txuj ci tseem ceeb rau cov neeg mob COVID-19 hnyav thoob ntiaj teb? Cov pab pawg Oxford University tau tshaj tawm tias tus nqi qis dexamethasone txo qis kev tuag txog li 33% hauv cov neeg mob hauv tsev kho mob uas muaj teeb meem ua pa hnyav ntawm COVID-19.

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References:

1. Villar, J., Confalonieri M., et al 2020. Qhov laj thawj rau Kev Kho Mob Corticosteroid ntev nyob rau hauv cov mob ua pa nyuaj uas tshwm sim los ntawm tus kab mob Coronavirus 2019. Crit Care Explor. 2020 Plaub Hlis Ntuj; 2 (4): e0111. Tshaj tawm online 2020 Plaub Hlis 29. DOI: https:///doi.org/10.1097/CCE.0000000000000111

2. Russell CD, Millar JE, Baillie JK. Cov pov thawj kho mob tsis txhawb kev kho corticosteroid rau 2019-nCoV mob ntsws. Lancet. 2020; 395:473–475 : kuv

3. Delaney JW, Pinto R, Long J, et al. Kev cuam tshuam ntawm kev kho corticosteroid ntawm qhov tshwm sim ntawm tus mob khaub thuas A(H1N1pdm09)-hais txog mob hnyav. Crit Care. 2016; 20:75 ib.

4. Chang L, Zhao J, Hu Y, et al. Ntawm kev siv corticosteroids rau 2019-nCoV pneumonia. Lancet. 2020; 395:683–684 : kuv

5. Nicastri E, Petrosillo N, Bartoli TA, et al. Lub koom haum National rau cov kab mob sib kis "L. Spallanzani", IRCCS. Cov lus pom zoo rau kev tswj xyuas chaw kho mob COVID-19. Kab Mob Dis Rep. 2020; 12:8543 XNUMX : kuv.

6. Oxford University Xov Xwm Tshaj Tawm. Lub Rau Hli 16, 2020. Tus nqi qis dexamethasone txo qis kev tuag txog li ib feem peb ntawm cov neeg mob hauv tsev kho mob uas muaj teeb meem ua pa hnyav ntawm COVID-19. Muaj nyob online ntawm https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf Nkag mus rau 16 Lub Rau Hli 2020.

7. Lu, X., Chen, T., Wang, Y. et al. Adjuvant corticosteroid therapy rau cov neeg mob hnyav nrog COVID-19. Crit Care 24, 241 (2020). Published 19 May 2020. DOI: https://doi.org/10.1186/s13054-020-02964-w

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