ABSTRACT

Introduction

The SARS-COV-2 pandemic is a worldwide public health problem due to the large medical burden and limited number of therapies available. Corticosteroids have a rather unclear efficacy in viral non-SARS-COV-2 pneumonias and therefore their use is not universally recommended. In SARS-COV-2 pneumonia however, it is expected that they can reduce the deleterious consequences of the virus-related systemic inflammation.

Areas covered

a MEDLINE search covering the period 1995–2020 was completed to identify relevant papers. SARS-COV-2 pathogenesis is very complex and is represented by the interplay of many cytokine-driven inflammation pathways. Its most severe form so called cytokine storm, is an exaggerate reaction of the host infected by the virus rapidly resulting in multiple organ dysfunction (MODS). Corticosteroids have the potential to blunt the inflammation response in such patients, but their efficacy is not the same for all patients. Further on the certainties and uncertainties regarding the efficacy of this therapy in SARS-COV-2 pneumonia are discussed

Expert Opinion

In patients with severe SARS-COV-2 pneumonia, corticosteroids can be efficacious, but it is still not clear if they can be safely used in patients with comorbid cardiovascular disease or how the optimal duration of therapy can be established.

中文翻译：

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皮质类固醇在 SARS-COV2 感染中的作用：临床实践中的确定性和不确定性

 抽象的

 介绍

由于巨大的医疗负担和可用的治疗方法数量有限，SARS-COV-2 大流行是一个全球性的公共卫生问题。皮质类固醇对病毒性非 SARS-COV-2 肺炎的疗效相当不清楚，因此不普遍推荐使用。然而，在 SARS-COV-2 肺炎中，预计它们可以减少病毒相关全身炎症的有害后果。

 覆盖领域

已完成涵盖 1995 年至 2020 年期间的 MEDLINE 检索，以识别相关论文。 SARS-COV-2 发病机制非常复杂，表现为许多细胞因子驱动的炎症途径的相互作用。其最严重的形式称为细胞因子风暴，是病毒感染宿主的过度反应，迅速导致多器官功能障碍（MODS）。皮质类固醇有可能减弱此类患者的炎症反应，但其疗效并非对所有患者都相同。进一步讨论了该疗法对 SARS-COV-2 肺炎疗效的确定性和不确定性

 专家意见

对于严重 SARS-COV-2 肺炎患者，皮质类固醇可能有效，但尚不清楚是否可以安全地用于合并心血管疾病的患者或如何确定最佳治疗持续时间。