在COVID-19中的使用:并非所有类固醇都是相同的

M. Tagliati, Marianna Leopoulou, J. LeQuang, Charles Wollmuth, J. Pergolizzi, Kailyn Mitchell, P. Magnusson
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引用次数: 1

摘要

导论:COVID-19的炎症机制表明,皮质类固醇可能是有益的,但其益处必须大于其潜在风险。RECOVERY试验结果表明,地塞米松6mg /天(但不包括其他类固醇)可能会降低COVID-19通气患者的死亡率。方法:回顾性分析新冠肺炎患者使用环来奈德和地塞米松的相关文献。文学正在迅速地被创造出来,这篇评论是作为一种最新的科学叙述提供的。结果:SARS-CoV-2病毒是一种RNA病毒,其RNA通过开放阅读框转录,使其难以被清除。冠状病毒已经进化出多种蛋白水解激活刺突的策略;病毒复制完全发生在细胞质中。在这方面,RNA切割核糖核酸内切酶(NSP-15,也称为EndoU)可能通过促进宿主巨噬细胞对病毒双链RNA的识别发挥关键作用。此外,该病毒能够快速进行RNA重组,使其能够逃避宿主免疫并产生耐药性。环来奈德是一种吸入性皮质类固醇,可减轻肺部炎症并阻断特定激酶的活性,这可能解释了其抗炎作用。已知地塞米松可降低COVID-19通气患者的死亡率。讨论:在以前的冠状病毒流行(SARS和MERS)中使用了全身皮质类固醇,这些患者的肺部组织学与COVID-19患者相似。急性呼吸窘迫综合征是大多数COVID-19感染的主要死亡原因,类固醇可能有效治疗这种由细胞因子风暴引起的疾病。然而,应该注意的是,吸入类固醇可能比全身治疗有更窄的效果窗口。结论:地塞米松已被证实可降低COVID-19通气患者的死亡率,可与吸入式环来奈德联合使用,环来奈德副作用少,可局部代谢。需要进一步的研究。
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Ciclesonide Use in COVID-19: Not All Steroids Are the Same
Introduction: The inflammatory mechanisms of COVID-19 suggest that corticosteroids may be beneficial, but their benefits must outweigh their potential risks. The RECOVERY trial results suggest that dexamethasone 6 mg/day (but not other steroids) may confer mortality benefits on ventilated COVID-19 patients. Methods: This is a narrative review of the literature about the use of ciclesonide and dexamethasone for COVID-19 patients. Literature is being created rapidly and this review is offered as a state-of-the-science narration. Results: The SARS-CoV-2 virus is an RNA virus whose RNA is transcribed via open reading frames, making its elimination difficult. Coronaviruses have evolved multiple strategies for proteolytic activation of the spike; viral replication occurs entirely in the cytoplasm. In this connection, the RNA-cleaving endoribonuclease (NSP-15 also known as EndoU) may play a key role by facilitating viral double-stranded RNA recognition by the host’s macrophages. Furthermore, the virus is able to undergo RNA recombination rapidly, enabling it to evade host immunity and develop drug resistance. Ciclesonide is an inhaled corticosteroid that reduces lung inflammation and blocks the activity of specific kinases which may explain its anti-inflammatory effect. Dexamethasone is known to reduce mortality in ventilated COVID-19 patients. Discussion: Systemic corticosteroids were used in previous coronavirus epidemics (SARS and MERS) and pulmonary histology of these patients is similar to those in COVID-19 patients. Acute respiratory distress syndrome is the main cause of death in most COVID-19 infections and steroids may be effective in addressing that condition, brought on by cytokine storm. However, it should be noted that inhaled steroids likely have a narrower window for effect than systemic regimens. Conclusion: Dexamethasone has been proven to confer mortality benefits on ventilated COVID-19 patients and may be used with inhaled ciclesonide, which has few side effects and can be locally metabolized. Further study is needed.
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