二甲双胍是降低重症新型冠状病毒肺炎病死率的可能选择之一?  

Metformin:one of the possible options to reduce the mortality of severe coronavirus disease 2019?

作　　者：潘永红 韩睿 何勇 Pan Yonghong;Han Rui;He Yong(Department of Pulmonary and Critical Care Medicine,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军特色医学中心呼吸与危重症医学科,重庆400042

出　　处：《中华危重病急救医学》2020年第9期1131-1134,共4页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81472189,81972189);重庆市临床重点专科建设项目(2018-553)。

摘　　要：从全世界疫情报告来看,2019新型冠状病毒肺炎(新冠肺炎)重症患者病死率高.糖尿病患者是新冠肺炎的易感人群,合并糖尿病的新冠肺炎患者病死率较高,所以认为高血糖是重症新冠肺炎的独立危险因素,针对感染新型冠状病毒(2019-nCoV)的重症患者目前也无确切有效的治疗方法.临床研究中观察到重症新冠肺炎患者体内出现"细胞因子风暴",持续高水平的细胞因子造成肺毛细血管内皮细胞及肺泡上皮细胞的弥漫性损伤,引起急性呼吸窘迫综合征(ARDS).ARDS是导致新冠肺炎患者死亡的主要原因.宿主导向疗法(HDT)是抗感染领域中的新兴治疗方法,可以激活人体自身保护性免疫反应,抑制过强的炎症反应,用于辅助传统药物治疗以缩短患者病程.二甲双胍被证实有宿主导向疗效,可以辅助治疗病毒和细菌感染性疾病.本文对二甲双胍辅助治疗重症新冠肺炎的合理性及潜在机制进行讨论,推测对重症新冠肺炎合并糖尿病患者使用二甲双胍进行降糖治疗,有可能预防或抑制ARDS发生,从而降低患者病死率,其作用机制可能是通过抑制白细胞介素-6(IL-6)信号通路,阻断"细胞因子风暴",延缓肺纤维化进程,抑制内吞作用,从而上调血管紧张素转换酶2(ACE2)表达.According to the world epidemic report,the mortality of patients with severe coronavirus disease 2019(COVID-19)is high.Diabetic patients are more susceptible to COVID-19.Since the mortality of COVID-19 patients with diabetes is on the top of list,hyperglycemia is considered an independent risk factor for severe COVID-19.Up to now,there is few effective treatment for severe patients infected with 2019 novel coronavirus(2019-nCoV).Clinical studies observed that cytokine storms existed in patients with severe COVID-19.Sustained high levels of cytokines cause diffuse damage to pulmonary capillary endothelial cells and alveolar epithelial cells,resulting in acute respiratory distress syndrome(ARDS).ARDS is the main cause of death in COVID-19 patients.Host-directed therapy(HDT)is an emerging therapeutic method in the field of anti-infection,which can activate the self-protective immune response,suppress excessive inflammatory response,and be used to assist the treatment of traditional drugs to shorten the course of disease.Metformin has been shown to be effective in HDT and can assist in the treatment of the viral and bacterial infectious disease.This paper discusses the rationality and potential therapeutic mechanism of metformin in the treatment of severe COVID-19.It was speculated that the use of metformin for controlling blood glucose in severe COVID-19 patients with diabetes may prevent or inhibit the occurrence of ARDS,thereby reducing the mortality of COVID-19 patients.The possible mechanism is that metformin could inhibit cytokine storm via suppressing interleukin-6(IL-6)signaling,prevent the process of lung fibrosis,suppress endocytosis,thereby elevating angiotensin converting enzyme 2(ACE2)expression.

关 键 词：新型冠状病毒肺炎 二甲双胍 宿主导向疗法 

分 类 号：R563.1[医药卫生—呼吸系统]