地塞米松和甲基泼尼松龙在重症新冠肺炎患者中的临床疗效和安全性

doi:10.5246/jcps.2025.04.026

中国药学(英文版) ›› 2025, Vol. 34 ›› Issue (4): 345-353.DOI: 10.5246/jcps.2025.04.026

地塞米松和甲基泼尼松龙在重症新冠肺炎患者中的临床疗效和安全性

刘增强¹, 刘文¹, 许凡凡²^,^*()

^1. 山东大学第二医院干部保健科, 山东济南 250033
^2. 山东大学第二医院急诊医学中心, 山东济南 250033

收稿日期:2025-01-10 修回日期:2025-02-08 接受日期:2025-03-11 出版日期:2025-05-02 发布日期:2025-05-02
通讯作者: 许凡凡

Comparative study on the efficacy and safety of dexamethasone and methylprednisolone for severe COVID-19

Zengqiang Liu¹, Wen Liu¹, Fanfan Xu²^,^*()

¹ Department of Health, Second Hospital of Shandong University, Jinan 250033, Shandong, China
² Emergency Medical Center, Second Hospital of Shandong University, Jinan 250033, Shandong, China

Received:2025-01-10 Revised:2025-02-08 Accepted:2025-03-11 Online:2025-05-02 Published:2025-05-02
Contact: Fanfan Xu
Supported by:
Cultivation fund in Second Hospital of Shandong University (Grant No. 2023YP11).

摘要/Abstract

摘要：

糖皮质激素被广泛用于治疗各种免疫和炎症相关疾病, 其在COVID-19治疗中的潜在用途引起了人们的广泛兴趣。本研究探讨了地塞米松和甲基泼尼松龙治疗重症COVID-19的疗效和安全性。本研究招募了94名18岁及以上重症新冠肺炎患者。他们接受静脉注射甲基泼尼松龙(40–80 mg/天)或地塞米松(5–10 mg/天)的治疗, 持续7–10天。本研究的主要目的是评估甲基泼尼松龙和地塞米松对死亡率的影响。此外, 本研究试图比较这些药物对各种参数的影响, 如氧合指数、炎症指数、真菌感染和高血糖, 作为次要终点。结果显示, 两组均无死亡病例, 地塞米松组有1例肺纤维化和烟曲霉感染, 甲基泼尼松龙组有2例曲霉菌感染。尽管缺乏统计学意义(P > 0.05), 甲基泼尼松龙组血氧饱和度改善比地塞米松组快, 中位时间为5天而不是7天。两组间c反应蛋白水平的改善情况, 差异无统计学意义(P > 0.05)。地塞米松与更高的高血糖发生率相关(P < 0.05)。地塞米松和甲基泼尼松龙均显著降低了严重COVID-19患者的死亡率, 血氧饱和度显著改善和炎症标志物显著降低。然而, 甲基泼尼松龙表现出更快的疗效发作和更少的不良反应。

关键词: 新型冠状病毒肺炎, 地塞米, 甲基泼尼松, 死亡率, 炎症介质, 真菌感染, 高血糖

Abstract:

Glucocorticoids are widely utilized for treating various immune and inflammation-related diseases, prompting significant interest in their potential application for COVID-19 treatment. This study explored the efficacy and safety of dexamethasone (DEX) and methylprednisolone (MP) in treating severe COVID-19. A cohort of 94 adult patients, aged 18 years and older, with severe COVID-19 was recruited. They received intravenous MP (40–80 mg/d) or DEX (5–10 mg/d) for 7–10 d. The primary objective was to assess the effects of these treatments on mortality rates. Additionally, the study aimed to compare the impact of these medications on various parameters, including the oxygenation index, inflammatory index, fungal infections, and hyperglycemia, serving as secondary endpoints. The findings revealed no fatalities in either group. However, there was one case of pulmonary fibrosis and Aspergillus fumigatus infection in the DEX group, and two cases of Aspergillus infection in the MP group. Although the differences were not statistically significant (P > 0.05), the MP group showed a faster improvement in blood oxygen saturation compared to the DEX group, with a median time of 5 d vs 7 d. No statistically significant difference was observed between the two groups regarding improvement in C-reactive protein levels (P > 0.05). Notably, DEX was associated with a higher incidence of hyperglycemia compared to MP (P < 0.05). Both DEX and MP significantly reduced mortality rates among patients with severe COVID-19 and improved blood oxygen saturation and inflammatory markers. However, MP exhibited a more rapid onset of efficacy and fewer adverse reactions.

Key words: COVID-19, Dexamethasone (DEX), Methylprednisolone (MP), Mortality rate, Inflammatory mediators, Fungal infection, Hyperglycemia

Supporting:

刘增强, 刘文, 许凡凡. 地塞米松和甲基泼尼松龙在重症新冠肺炎患者中的临床疗效和安全性[J]. 中国药学(英文版), 2025, 34(4): 345-353.

Zengqiang Liu, Wen Liu, Fanfan Xu. Comparative study on the efficacy and safety of dexamethasone and methylprednisolone for severe COVID-19[J]. Journal of Chinese Pharmaceutical Sciences, 2025, 34(4): 345-353.

图/表 6

Table 1. Comparisons of the DEX and MP groups in terms of baseline data.

Table 2. Comparisons of the DEX and MP groups in terms of heart rate and respiratory rate.

Table 3. Comparisons of the DEX and MP groups in terms of PaO2.

Table 4. Comparisons of the DEX and MP groups in terms of inflammatory mediators.

Table 5. Comparisons of the DEX and MP groups in terms of adverse reactions.

Figure 1. The Kaplan-Meier curve for DEX and MP groups.

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地塞米松和甲基泼尼松龙在重症新冠肺炎患者中的临床疗效和安全性

Comparative study on the efficacy and safety of dexamethasone and methylprednisolone for severe COVID-19

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