摘要目的:研究中低剂量糖皮质激素治疗对新型冠状病毒肺炎(COVID-19)患者病毒清除时间的影响。方法:回顾性分析2020年1月19日至2月17日浙江大学医学院附属第一医院收治的72例COVID-19患者的临床资料。全部患者均接受阿比多尔和/或联合洛匹那韦/利托那韦、达芦那韦/考比司他抗病毒以及对症支持治疗，其中51例使用甲泼尼龙(0.75～1.50 mg·kg －1·d －1)抗炎治疗作为糖皮质激素治疗组，21例未使用糖皮质激素者作为对照组。比较两组患者及普通型患者痰液病毒核酸转阴时间和肺部影像学改善时间。组间比较采用Kruskal-Wallis检验或Fisher精确检验。 结果:糖皮质激素治疗组与对照组中位年龄分别为52(45，62)和46(32，56)岁，两组比较差异有统计学意义( χ2＝4.365， P<0.05)。两组临床分型差异有统计学意义( P<0.01)，糖皮质激素治疗组中重型患者占52.0%，而对照组中普通型占71.4%。两组患者从发病至痰液病毒核酸转阴中位时间分别为15(13，20)和14(12，20) d，差异无统计学意义( P>0.05)；两组患者从发病至肺部影像学好转中位时间分别为13(11，15)和13(12，17) d，差异无统计学意义( P>0.05)。在普通型患者中，糖皮质激素治疗组与对照组从发病至痰液病毒核酸转阴中位时间为13(11，18)和13(12，15) d，差异无统计学意义( P>0.05)；从发病至肺影像学好转中位时间分别为12(10，15)和13(12，17) d，差异也无统计学意义( P>0.05)。 结论:在不同临床类型的COVID-19患者中，中低剂量糖皮质激素使用对病毒清除时间未见明显影响；普通型患者中未观察到激素可以加快肺损伤的改善，故不建议使用。

abstractsObjective:To study the effect of low-to-moderate dose glucocorticoid therapy on viral clearance in patients with COVID-19.Methods:A total of 72 patients diagnosed with COVID-19 from January 19 to February 17, 2020 at the First Affiliated Hospital, Zhejiang University School of Medicine were recruited. All patients received oral arbidol and combination of lopinavir/ritonavir or darunavir/cobistitat for antiviral therapy, and symptomatic supportive care. Among them, 51 patients received methylprednisolone (0.75-1.50 mg·kg -1·d -1) (glucocorticoid treatment group), and 21 patients did not use glucocorticoid (control group). The time of virologic negative conversion in sputum and the time of radiologic recovery in lung since onset were compared between the two groups. The Kruskal-Wallis test or Fisher exact test was used to compare the difference between groups. Results:The median ages of the glucocorticoid group and the control group were 52 (45, 62) and 46 (32, 56) years ( χ2=4.365, P<0.05). The clinical conditions at hospital admission were different between the two groups ( P<0.01). The severe cases accounted for 52.0%, while moderate cases in the control group accounted for 71.4%. The median times from the onset to virologic negative conversion in the two groups were 15 (13, 20) and 14 (12, 20) days ( P>0.05). The median times from onset to radiologic recovery were 13 (11, 15) and 13 (12, 17) days in the two groups ( P>0.05). In moderate cases, the median times from the onset to virologic conversion in sputum were 13 (11, 18) days in the glucocorticoid group and 13 (12, 15) days in the control group ( P>0.05). The median times from onset to radiologic recovery in lung were 12 (10, 15) and 13 (12, 17) days, respectively ( P>0.05). Conclusions:Low-to-moderate glucocorticoid treatment has no effect on the time of virus clearance in patients with different clinical types of COVID-19, and also no effect on accelerating radiologic recovery in lung, so it is not recommended.