Lopinavir/ritonavir is associated with pneumonia resolution in COVID-19 patients with influenza coinfection: A retrospective matched-pair cohort study
Lopinavir/ritonavir is associated with pneumonia resolution in COVID-19 patients with influenza coinfection: A retrospective matched-pair cohort study
复制标题
洛匹那韦/利托那韦与流感合并感染的 COVID-19 患者的肺炎缓解相关：一项回顾性配对队列研究
DOI：
10.1002/jmv.26260
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发表时间：
2020-07-15
影响因子：
12.7
通讯作者：
Zeng, Rui
中科院分区：
文献类型：
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作者：
Yu, Chong;Zhang, Zhiguo;Zeng, Rui
于疫情初期，部分冠状病毒病（COVID-19）患者被误诊为流感，令人关注到部分流感导致的死亡实际上与COVID-19有关。然而，关于与流感合并感染是否会导致COVID-19肺炎的严重程度以及这些患者的最佳治疗策略，人们知之甚少。我们回顾性研究了128例COVID-19肺炎住院患者。所有患者核酸检测均为SARS冠状病毒2型阳性。64例合并感染甲型/B型流感，其他64例为流感阴性，年龄、性别和症状发作天数相匹配。在64例合并感染患者中，54例（84.4%）合并感染甲型流感，10例（15.6%）合并感染B型流感。合并感染流感的患者从入院到病毒排出的中位持续时间（17.0天）长于未合并感染流感的患者（12.0天）（P <0.001）。多变量考克斯比例风险模型显示，与未使用洛匹那韦/利托那韦的患者相比，使用洛匹那韦/利托那韦的患者肺部受累消退的风险比为1.878（P = .020）（95%置信区间：1.103-3.196）。在流感合并感染的患者中，使用洛匹那韦/利托那韦治疗的患者在症状发作后2周内肺炎消退更快（37% vs 1%;P = 0.001）。流感合并感染组和未感染组的肺部受累率无差异。洛匹那韦/利托那韦消除了流感合并感染组和非感染组之间肺部受累的差异，表明洛匹那韦/利托那韦与COVID-19肺炎消退相关。
During the early stages of the pandemic, some coronavirus disease (COVID-19) patients were misdiagnosed as having influenza, which aroused the concern that some deaths attributed to influenza were actually COVID-19-related. However, little is known about whether coinfection with influenza contributes to severity of COVID-19 pneumonia, and the optimal therapeutic strategy for these patients. We retrospectively studied 128 hospitalized patients with COVID-19 pneumonia. All patients were positive severe acute respiratory syndrome coronavirus 2 positive by nucleic acid detection. Sixty-four cases were coinfected with influenza A/B and the other 64 were influenza negative, matched by age, sex, and days from onset of symptoms. Among the 64 coinfected patients, 54 (84.4%) were coinfected with influenza A, and 10 (15.6%) with influenza B. The median duration of viral shedding time from admission was longer for patients with influenza coinfection (17.0 days) than for those without influenza coinfection (12.0 days) (P < .001). The multivariable Cox proportional hazards model showed that the hazards ratio of resolution in lung involvement was 1.878 (P = .020) for patients administered lopinavir/ritonavir, compared with those not administered lopinavir/ritonavir (95% confidence interval: 1.103-3.196). Among influenza coinfected patients, those treated with lopinavir/ritonavir exhibited faster pneumonia resolution within 2 weeks after symptom onset (37% vs 1%;P = .001). There was no difference in lung involvement between influenza coinfected and noninfected groups. Lopinavir/ritonavir eliminated the difference of lung involvement between influenza coinfected and noninfected groups, indicating that lopinavir/ritonavir is associated with pneumonia resolution in COVID-19.