Beneficial aspects of high dose intravenous vitamin C on patients with COVID-19 pneumonia in severe condition: a retrospective case series study
Beneficial aspects of high dose intravenous vitamin C on patients with COVID-19 pneumonia in severe condition: a retrospective case series study
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大剂量静脉注射维生素 C 对重症 COVID-19 肺炎患者的益处：回顾性病例系列研究
DOI：
10.21037/apm-20-1387
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发表时间：
2021-02-01
影响因子：
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通讯作者：
Mao, Enqiang
中科院分区：
文献类型：
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作者：
Zhao, Bing;Ling, Yun;Mao, Enqiang
背景：冠状病毒病2019(新冠肺炎)是一场至今没有特定治疗药物的全球性公共卫生事件。目的：探讨大剂量静脉注射维生素C对重症新冠肺炎患者的治疗效果。方法：对2020年1月22日至2020年4月11日上海公共卫生临床中心收治的新冠肺炎患者进行回顾性分析。入选患者为确诊为重症或危重新冠肺炎肺炎的患者，病情加重后24小时内接受了高密度脂蛋白体外循环治疗。结果：共入选12例患者，其中重度患者6例，平均年龄56岁；四分位数范围(IQR)32~65岁，男性3例；危重患者6例，平均年龄63岁；IQR 60~82岁，男性4例。维生素C用量中位数为162.7(71.1~328.6)，危重病人为178.6(133.3~350.6)。广义估计方程(GEE)模型显示，C反应蛋白在发病第3、7天显著下降(重度：59.01+/-37.9、12.36+/-22.12、8.95+20.4 mg/L；临界：92.5+/-41.21、33.9+/-30.2、59.56+/-41.4 mg/L)。重症患者的PaO2/FiO(2)(重症：209.3+/-111.7、313.4+/-146、423.3+/-140.8；危重：119.9+/-52.7、201.8+/-86.64、190.5+/-51.99)和序贯器官衰竭评分(严重：2.83+/-1.72、1.33+/-1.63、0.67+/-1.03；严重程度：6.67+/-2.34、4.17+/-2.32、3.83+/-2.56)。重症患者的改善效果优于危重患者。结论：高强度下腔静脉有利于新冠肺炎患者炎症反应、免疫功能和脏器功能的改善。进一步的临床试验是有必要的。
Background: Coronavirus disease 2019 (COVID-19) is a global public health event without specific therapeutic agents till now. We aim to determine if high dose intravenous vitamin C (HDIVC) was effective for COVID-19 patients in severe condition.Methods: COVID-19 patients admitted in Shanghai Public Health Clinical Center from January 22, 2020 to April 11, 2020 were retrospectively scrolled. The enrolled patients were those with confirmed diagnosis of severe or critical COVID-19 pneumonia, who received HDIVC within 24 hours after disease aggravation. Main clinical outcomes obtained from 3-5 days (day 3) and 7-10 days (day 7) after HDIVC were compared to the ones just before (day 0) HDIVC.Results: Totally, twelve patients were enrolled including six severe [age of mean, 56; interquartile range (IQR), 32-65 years, 3 men] and six critical (age of mean, 63; IQR, 60-82 years, 4 men) patients. The dosage of vitamin C [median (IQR), mg/kg ( body weight)/day] were 162.7 (71.1-328.6) for severe and 178.6 (133.3-350.6) for critical patients. By Generalized estimating equation (GEE) model, C-reactive protein (CRP) was found to decrease significantly from day 0 to 3 and 7 (severe: 59.01 +/- 37.9, 12.36 +/- 22.12, 8.95 +/- 20.4 mg/L; critical: 92.5 +/- 41.21, 33.9 +/- 30.2, 59.56 +/- 41.4 mg/L). Lymphocyte and CD4+ T cell counts in severe patients reached to normal level since day 3. Similar improving trends were observed for PaO2/FiO(2) (severe: 209.3 +/- 111.7, 313.4 +/- 146, 423.3 +/- 140.8; critical: 119.9 +/- 52.7, 201.8 +/- 86.64, 190.5 +/- 51.99) and sequential organ failure assessment score (severe: 2.83 +/- 1.72, 1.33 +/- 1.63, 0.67 +/- 1.03; critical: 6.67 +/- 2.34, 4.17 +/- 2.32, 3.83 +/- 2.56). Better improving effect was observed in severe than critical patients after HDIVC.Conclusions: HDIVC might be beneficial in aspects of inflammatory response, immune and organ function for aggravation of COVID-19 patients. Further clinical trials are in warrant.