SARS: pharmacotherapy
SARS: pharmacotherapy
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DOI：
10.1046/j.1440-1843.2003.00525.x
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发表时间：
2003-11-01
期刊：
影响因子：
6.9
通讯作者：
Zhong, NS
中科院分区：
文献类型：
--
作者：
Tsang, K;Zhong, NS
严重急性呼吸系统综合症（SARS）的药物治疗是有争议的，主要是轶事。大多数怀疑患有SARS的患者在开始“抗SARS”治疗之前应首先使用强效抗生素治疗。SARS的严重程度和进展速度是有谱的，病毒复制、炎症性肺炎和残余肺纤维化的分期在临床上无明显差异。虽然现在被认为缺乏疗效，利巴韦林在香港被广泛用于治疗SARS。回顾性数据表明，使用抗蛋白酶Kaletra（利托那韦和洛匹那韦）可以降低死亡率并改善预后，尽管不良反应也令人担忧。轶事经验强烈支持使用类固醇，至少在一部分SARS患者中，特别是表现出持续临床不稳定或恶化以及放射学或HRCT进行性恶化的“危重SARS”患者。一项对72名疑似SARS患者进行的回顾性研究表明，接受脉冲甲基戊二龙治疗的患者在累积类固醇剂量或不良反应方面没有差异，尽管前者患者的需氧量较低，放射学结果较好，并且需要脉冲类固醇治疗的可能性较低。然而，较低剂量的类固醇作为SARS的初始治疗也与良好的临床结果相关。对初始治疗反应较差的患者可能受益于补救性类固醇治疗或静脉注射五血红蛋白。在绝望的病人身上也尝试过其他药物治疗，包括使用恢复期血清和血浆置换。继发感染可能很麻烦，特别是对于长期住院和机械通气的患者。
The pharmacotherapy for severe acute respiratory syndrome (SARS) is controversial and largely anecdotal. Most patients with suspected SARS should initially be treated with potent antibiotics before proceeding to 'anti-SARS' therapy. There is a spectrum of severity and rate of progression in SARS, and the stages of viral replication, inflammatory pneumonitis and residual pulmonary fibrosis are clinically non-distinct. Although now considered lacking in efficacy, ribavirin was used extensively in Hong Kong for treatment of SARS. Retrospective data suggest that the use of Kaletra (ritonavir and lopinavir), an anti-protease, could reduce mortality and improve outcomes, although the adverse reactions are also worrisome. Anecdotal experience strongly supports the use of steroid, at least in a subset of SARS patients, particularly with 'critical SARS' who display continued clinical instability or deterioration and progressive radiographic or HRCT deterioration. A retrospective study carried out of 72 probable SARS patients has shown that cases who received pulse methylprendisolone did not differ in cumulative steroid dosage or adverse reactions, although the former patients had less oxygen requirement, better radiographic outcome, and less likelihood of requiring rescue pulse steroid therapy than their counterparts. Nevertheless, lower dosage of steroid as initial therapy in SARS had also been associated with good clinical outcomes. Poor responders to initial therapy might benefit from rescue steroid therapy or intravenous Pentaglobin. Other drug treatments had also been tried in desperate patients, including the use of convalescence serum and plasmapheresis. Secondary infections could be troublesome, particular for patients with prolonged hospitalization and mechanical ventilation.