阿兹夫定治疗新型冠状病毒感染高危患者的真实世界研究  

Real-world efficacy of azvudine in high-risk patients with coronavirus disease 2019

作　　者：刘逸枫 封启明[1] 朱晓光 童译庆 张健明 仲伟喜 Liu Yifeng;Feng Qiming;Zhu Xiaoguang;Tong Yiqing;Zhang Jianming;Zhong Weixi(Emergency Department,Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属第六人民医院急诊医学科,上海200025

出　　处：《中国急救医学》2024年第7期622-626,共5页Chinese Journal of Critical Care Medicine

基　　金：促进市级医院临床技能与临床创新能力三年行动计划项目(SHDC2020CR6030)。

摘　　要：目的 探讨阿兹夫定用于治疗新型冠状病毒感染高危患者的疗效。方法 收集2022年12月8日至2023年1月31日上海交通大学医学院附属第六人民医院急诊医学科就诊的新型冠状病毒感染患者的临床资料。以年龄校正查尔森合并症指数(age-adjusted Charlson comorbidity index, aCCI)≥1分筛选出高危患者379例,根据使用不同抗病毒治疗药物分为阿兹夫定组(221例)和其他药物组(奈玛特韦/利托那韦和莫诺拉韦,158例),并设定年龄、性别、体重指数(BMI)和aCCI作为混杂因素,采用1∶1倾向性评分匹配方法,比较匹配后两组患者预后差异,评价使用阿兹夫定进行抗病毒治疗的效果。主要预后指标为确诊后60 d内病死率,次要预后指标为住院率、重症率、高级呼吸支持使用率、抗原核酸转阴时间、症状缓解时间。结果 阿兹夫定组患者平均年龄小于其他药物组[岁:(74.0±12.8) vs.(77.1±13.2)],平均aCCI评分低于其他药物组[分:4(3,5)vs. 4(3,6)],差异均有统计学意义(P均<0.05)。匹配后两组各纳入患者136例,两组患者年龄、性别、aCCI和BMI等混杂因素差异无统计学意义(P>0.05)。匹配后阿兹夫定组较其他药物组住院率高(80.1%vs.50.5%,P<0.001)、平均核酸抗原转阴时间长(d:10.0 vs. 7.0,P=0.003)、平均症状缓解时间长(d:14.0 vs. 11.0,P=0.019)、病死率低(8.1%vs.17.6%,P=0.019)以及高级呼吸支持使用率低(11.0%vs.21.3%,P=0.021)。Logistic回归分析显示,使用阿兹夫定是具有高危因素的新型冠状病毒感染患者发生死亡(OR=0.436,P=0.023)和使用高级呼吸支持(OR=0.457,P=0.023)的保护因素。结论 与奈玛特韦片/利托那韦和莫诺拉韦相较,阿兹夫定治疗具有高危因素的新型冠状病毒感染患者,在降低病死率、减少高级呼吸支持使用率方面有更好临床疗效。Objective To evaluate the efficacy of azvudine in the treatment of high-risk patients with coronavirus disease 2019(COVID-19).Methods The clinical data of patients with COVID-19 infection who visited the Emergency Department of Shanghai Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from December 8,2022 to January 31,2023 were collected.A total of 379 high-risk patients(age-adjusted Charlson comorbidity index,aCCI≥1 score)were screened and divided into azvudine group(n=221)and other drug group(nirmatrelvir/ritonavir,molnupiravir,n=158)according to the different drugs of antiviral therapy.Confounding factors such as age,gender,body mass index(BMI),and aCCI were set as covariates,with a 1∶1 propensity score matching method employed.The prognosis difference between the two groups were compared after matching to evaluate the efficacy of antiviral therapy with azvudine.The primary prognostic indicator was the 60-day mortality after diagnosis,and the secondary prognostic indicators were hospitalization rate,the rate of severe cases,usage rate of advanced respiratory support,nucleic acid/antigen turning-to-negative time,and relief time of clinical symptom.Results The average age of patients in the azvudine group was younger than that in the other drug groups with a statistically significant difference(years:74.0±12.8 vs.77.1±13.2),and the average aCCI of patients in the azvudine group was lower than that in the other drug groups with a statistically significant difference[scores:4(3,5)vs.4(3,6),P<0.05].After matching,136 patients were included in each of the two groups.There were no statistically significant differences in age,sex,aCCI,BMI and other confounding factors between the two groups(P>0.05).Compared with the other drug groups,the azvudine group had a higher hospitalization rate(50.5%vs.80.1%,P<0.001),a longer nucleic acid/antigen turning-to-negative time(d:7.0 vs.10.0,P=0.003),a longer relief time of clinical symptom(d:11.0 vs.14.0,P=0.019),a lower mortality rate(

关 键 词：阿兹夫定 新型冠状病毒 预后 真实世界研究 倾向性评分 高危 

分 类 号：R511[医药卫生—内科学]