Please wait a minute...
浙江大学学报（医学版）
浙江大学学报（医学版）  2020, Vol. 49 Issue (2): 215-219    DOI: 10.3785/j.issn.1008-9292.2020.03.03
原著     
硫酸羟氯喹治疗2019冠状病毒病(COVID-19)普通型患者的初步研究
陈军(),刘丹萍,刘莉,刘萍,徐庆年,夏露,凌云,黄丹,宋树丽,张丹丹,钱志平,李涛,沈银忠,卢洪洲*()
上海市公共卫生临床中心感染与免疫科, 上海 201508
A pilot study of hydroxychloroquine in treatment of patients with moderate COVID-19
CHEN Jun(),LIU Danping,LIU Li,LIU Ping,XU Qingnian,XIA Lu,LING Yun,HUANG Dan,SONG Shuli,ZHANG Dandan,QIAN Zhiping,LI Tao,SHEN Yinzhong,LU Hongzhou*()
Department of Infection and Immunity, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
 全文: PDF(1044 KB)   HTML( 3068 )
摘要：

目的: 初步评价硫酸羟氯喹治疗2019冠状病毒病（COVID-19）普通型患者的疗效和安全性。方法: 收集2020年2月6至25日在上海市公共卫生临床中心住院治疗的30例COVID-19普通型患者。患者1：1随机分配到试验组和对照组。对照组接受常规治疗，试验组在常规治疗的基础上口服硫酸羟氯喹（400 mg，1次/d）治疗，疗程为5 d。比较两组治疗第7天时咽拭子病毒核酸转阴率等指标。研究获上海市公共卫生临床中心伦理委员会批准，并登记注册（NCT04261517）。结果: 在治疗过程中，试验组1例患者发展为重型。入组后第7天，试验组中13例（86.7%）和对照组中14例（93.3%）患者咽拭子病毒核酸检测为阴性（P>0.05）。在2周的访视期内，所有受试者的咽拭子核酸检测均转为阴性，其中试验组咽拭子核酸转阴时间为入院后第4（1，9）天，对照组为第2（1，4）天，差异无统计学意义（Z=1.27，P>0.05）。试验组在入院后第1（0，2）天体温恢复正常，对照组在入院后第1（0，3）天体温恢复正常。影像学检查结果显示，试验组5例（33.3%）和对照组7例（46.7%）患者均在入院3 d后的复查中出现了进展，所有患者在随后的复查中均提示病灶好转。试验组和对照组分别有4例（26.7%）和3例（20.0%）患者出现一过性的腹泻和肝功能异常等不良反应，两组不良反应发生率差异无统计学意义（P>0.05）。结论: 目前COVID-19普通型患者预后较好，以病毒转阴率、重症化率为主要终点的研究难以对药物的疗效进行判断。开展后续的研究需要确定更合适的人群和终点事件，并充分考虑样本量等试验的可行性问题。
关键词： 2019冠状病毒病;  严重急性呼吸综合征冠状病毒2;  新型冠状病毒肺炎;  羟氯喹;  治疗结果;  安全性;  随机对照试验    
Abstract:

Objective: To evaluate the efficacy and safety of hydroxychloroquine (HCQ) in the treatment of patients with moderate coronavirus disease 2019 (COVID-19). Methods: We prospectively enrolled 30 treatment-naïve patients with confirmed COVID-19 after informed consent at Shanghai Public Health Clinical Center. The patients were randomized 1:1 to HCQ group and the control group. Patients in HCQ group were given HCQ 400 mg per day for 5 days plus conventional treatments, while those in the control group were given conventional treatment only. The primary endpoint was negative conversion rate of SARS-CoV-2 nucleic acid in respiratory pharyngeal swab on days 7 after randomization. This study has been approved by the Ethics Committee of Shanghai Public Health Clinical Center and registered online (NCT04261517). Results: One patient in HCQ group developed to severe during the treatment. On day 7, nucleic acid of throat swabs was negative in 13 (86.7%) cases in the HCQ group and 14 (93.3%) cases in the control group (P>0.05). The median duration from hospitalization to virus nucleic acid negative conservation was 4 (1, 9) days in HCQ group, which is comparable to that in the control group [2 (1, 4) days, Z=1.27, P>0.05]. The median time for body temperature normalization in HCQ group was 1 (0, 2) day after hospitalization, which was also comparable to that in the control group [1 (0, 3) day]. Radiological progression was shown on CT images in 5 cases (33.3%) of the HCQ group and 7 cases (46.7%) of the control group, and all patients showed improvement in follow-up examinations. Four cases (26.7%) of the HCQ group and 3 cases (20%) of the control group had transient diarrhea and abnormal liver function (P>0.05). Conclusions: The prognosis of COVID-19 moderate patients is good. Larger sample size study are needed to investigate the effects of HCQ in the treatment of COVID-19. Subsequent research should determine better endpoint and fully consider the feasibility of experiments such as sample size.
Key words: Coronavirus disease 2019    Severe acute respiratory syndrome coronavirus 2    Novel coronavirus pneumonia    Hydroxychloroquine    Treatment outcome    Safety    Randomized controlled trial
收稿日期: 2020-02-29 出版日期: 2020-03-06
:  R512.99  
基金资助: 上海市科学技术委员会应急科技攻关专项(20431900103);复旦大学一流大学和一流学科建设项目(IDF162005);浙江大学新型冠状病毒(2019-nCoV)肺炎应急科研专项(2020XGZX030);上海市公共卫生临床中心新型冠状病毒"2019-nCoV"科研攻关院内专项(2020YJKY01);上海市重点专科传染病项目(shslczdzk01102);上海市"医苑新星"医学人才项目(2019-72)
通讯作者: 卢洪洲     E-mail: qtchenjun@163.com;luhongzhou@fudan.edu.cn
作者简介: 陈军(1984—), 男, 博士, 副主任医师, 主要从事感染性疾病的诊治和发病机制研究; E-mail:qtchenjun@163.com; https://orcid.org/0000-0002-3850-4875
服务　　
把本文推荐给朋友
加入引用管理器
E-mail Alert
RSS
作者相关文章　　
陈军
刘丹萍
刘莉
刘萍
徐庆年
夏露
凌云
黄丹
宋树丽
张丹丹
钱志平
李涛
沈银忠
卢洪洲

引用本文:

陈军,刘丹萍,刘莉,刘萍,徐庆年,夏露,凌云,黄丹,宋树丽,张丹丹,钱志平,李涛,沈银忠,卢洪洲. 硫酸羟氯喹治疗2019冠状病毒病(COVID-19)普通型患者的初步研究[J]. 浙江大学学报（医学版）, 2020, 49(2): 215-219.

CHEN Jun,LIU Danping,LIU Li,LIU Ping,XU Qingnian,XIA Lu,LING Yun,HUANG Dan,SONG Shuli,ZHANG Dandan,QIAN Zhiping,LI Tao,SHEN Yinzhong,LU Hongzhou. A pilot study of hydroxychloroquine in treatment of patients with moderate COVID-19. J Zhejiang Univ (Med Sci), 2020, 49(2): 215-219.

链接本文:

http://www.zjujournals.com/med/CN/10.3785/j.issn.1008-9292.2020.03.03    或    http://www.zjujournals.com/med/CN/Y2020/V49/I2/215

组别 n 男性* 平均年龄
(岁)		 平均病程(d) 发热 基础疾病* 白细胞计数(×109/L) 淋巴细胞计数
(×109/L)		 ALT
(U/L)		 eGFR
(mL·min-1·1.73m-2)		 乳酸
(mmol/L)		 CD4+细胞
计数(/μL)		 胸部CT病灶
(两肺/一侧肺)*
高血压 糖尿病 慢性阻塞性肺疾病
  “—”无相关数据.*Fisher检验.ALT：丙氨酸转氨酶；eGFR：肾小球滤过率估值.
试验组 15 9(60.0) 50.5±3.8 6.6±3.9 9(60.0) 5(33.3) 1(6.7) 0(0.0) 5.2(3.9，6.7) 1.11±0.43 18(15，23) 117±29 1.4±0.4 415(275，589) 12/3
对照组 15 12(80.0) 46.7±3.6 5.9±4.1 13(86.7) 3(20.0) 1(6.7) 1(6.7) 4.9(4.5，7.4) 1.18±0.55 24(14，47) 120±29 1.4±0.5 395(272，710) 14/1
t/U值 — — 0.72 0.45 — — — — 101 0.39 87 0.30 0.19 110 —
P值 — ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05 ＞0.05
表 1  两组人口学资料和临床特征比较
1 CHAN J F , YUAN S , KOK K H et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster[J]. Lancet, 2020, 395 (10223): 514- 523
doi: 10.1016/S0140-6736(20)30154-9
2 Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV)[EB/OL]. (2020-01-31)[2020-02-26] https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-(2019-ncov).
3 LU R , ZHAO X , LI J et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding[J]. Lancet, 2020, 395 (10224): 565- 574
doi: 10.1016/S0140-6736(20)30251-8
4 LU H . Drug treatment options for the 2019-new coronavirus (2019-nCoV)[J]. Biosci Trends, 2020, 14 (1):
doi: 10.5582/bst.2020.01020
5 SAVARINO A , BOELAERT J R , CASSONE A et al. Effects of chloroquine on viral infections: an old drug against today's diseases?[J]. Lancet Infect Dis, 2003, 3 (11): 722- 727
doi: 10.1016/s1473-3099(03)00806-5
6 SHUKLA A M , WAGLE SHUKLA A . Expanding horizons for clinical applications of chloroquine, hydroxychloroquine, and related structural analogues[J]. Drugs Context, 2019, 8 2019-9- 1
doi: 10.7573/dic.2019-9-1
7 VINCENT M J , BERGERON E , BENJANNET S et al. Chloroquine is a potent inhibitor of SARS coronavirus infection and spread[J]. Virol J, 2005, 2 69
doi: 10.1186/1743-422X-2-69
8 中华人民共和国国家卫生健康委员会办公厅, 国家中医药管理局办公室.新型冠状病毒感染的肺炎诊疗方案(试行第六版)[A/OL].国卫办医涵〔2020〕145号.(2020-02-18)[2020-02-28].http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml.
General Office of National Health Commission of the People's Republic of China, Office of National Administration of Traditional Chinese Medicine. Diagnosis and treatment of novel coronavirus pneumonia (trial version 6)[A/OL]. No.145〔2020〕 of the General Office of the National Health Commission. (2020-02-18)[2020-02-28]. http://www.nhc.gov.cn/yzygj/s7653p/202002/8334a8326dd94d329df351d7da8aefc2.shtml.(in Chinese)
9 中国临床试验注册中心.[2020-02-25].http://www.chictr.org.cn.
Chinese Clinical Trail Registry.[2020-02-25].http://www.chictr.org.cn. (in Chinese)
10 陈军, 凌云, 席秀红 et al. 洛匹那韦利托那韦和阿比多尔用于治疗新型冠状病毒肺炎的有效性研究[J]. 中华传染病杂志, 2020, 38
CHEN Jun , LING Yun , XI Xiuhong et al. Efficacies of lopinavir/ritonavir and abidol in the treatment of novel coronavirus pneumonia[J]. Chinese Journal of Infectious Diseases, 2020, 38
doi: 10.3760/cma.j.cn311365-20200210-00050
11 陈峰, 郝元涛, 张志杰 et al. 关于科学、规范、有序地开展新型冠状病毒肺炎相关临床试验的建议[J]. 中华流行病学杂志, 2020, 41 (3): 301- 302
CHEN Feng , HAO Yuantao , ZHANG Zhijie et al. An urgent call for raising the scientific rigorousness of clinical trials on COVID-19[J]. Chinese Journal of Epidemiology, 2020, 41 (3): 301- 302
doi: 10.3760/cma.j.issn.0254-6450.2020.03.004
[1] 曹盛力,冯沛华,时朋朋. 修正SEIR传染病动力学模型应用于湖北省2019冠状病毒病(COVID-19)疫情预测和评估[J]. 浙江大学学报（医学版）, 2020, 49(2): 178-184.
[2] 陈志敏,傅君芬,舒强,汪伟,陈英虎,华春珍,李甫棒,林茹,唐兰芳,汪天林,王颖硕,徐玮泽,杨子浩,叶盛,袁天明,张晨美,张园园. 儿童2019冠状病毒病(COVID-19)诊疗指南(第二版)[J]. 浙江大学学报（医学版）, 2020, 49(2): 139-146.
[3] 徐凯进,蔡洪流,沈毅弘,倪勤,陈瑜,胡少华,李剑平,王华芬,俞亮,黄河,裘云庆,魏国庆,方强,周建英,盛吉芳,梁廷波,李兰娟. 2019冠状病毒病(COVID-19)诊疗浙江经验[J]. 浙江大学学报（医学版）, 2020, 49(2): 147-157.
[4] 姜赛平,李璐,茹仁萍,张春红,饶跃峰,林彬,王融溶,陈娜,王小娟,蔡洪流,盛吉芳,周建英,卢晓阳,裘云庆. 2019冠状病毒病(COVID-19)重型、危重型患者用药管理经验[J]. 浙江大学学报（医学版）, 2020, 49(2): 158-169.
[5] 李鑫,代甜,王虹,石军年,袁薇,栗静,陈利军,张天明,张珊珊,孔焱,岳宁,时慧,何玉苹,胡惠芳,柳芙蓉,杨彩霞. 2019冠状病毒病(COVID-19)疑似患者合并焦虑和抑郁的临床分析[J]. 浙江大学学报（医学版）, 2020, 49(2): 203-208.
[6] 骆嵩,杨丽娟,王春,刘传苗,李殿明. 血浆置换和托珠单抗治疗六例2019冠状病毒病(COVID-19)重型患者临床分析[J]. 浙江大学学报（医学版）, 2020, 49(2): 227-231.
[7] 洪东升,倪剑,单文雅,李璐,胡希,羊红玉,赵青威,张幸国. 基于监测数据的药物不良反应快速识别及R语言实现[J]. 浙江大学学报（医学版）, 2020, 49(2): 253-259.
[8] 钟琦,李志,沈晓勇,徐凯进,沈毅弘,方强,陈峰,梁廷波. 2019冠状病毒病(COVID-19)不同临床分型患者胸部CT影像学特征[J]. 浙江大学学报（医学版）, 2020, 49(2): 198-202.
[9] 康仙慧,张荣,何慧梁,姚永兴,郑跃英,温小红,祝胜美. 一例妊娠合并2019冠状病毒病(COVID-19)患者的剖宫产麻醉管理[J]. 浙江大学学报（医学版）, 2020, 49(2): 249-252.
[10] 陈旭,李央,王金希,蔡洪流,曹红翠,盛吉芳. 三例妊娠合并2019冠状病毒病(COVID-19)患者诊治分析[J]. 浙江大学学报（医学版）, 2020, 49(2): 240-244.
[11] 沈利华,黄菲,陈祥,熊钻,杨晓玉,李慧,程丰,郭健,龚国富. 严重急性呼吸综合征冠状病毒2(SARS-CoV-2)核酸检测试剂盒临床诊断效能评估[J]. 浙江大学学报（医学版）, 2020, 49(2): 185-190.
[12] 张胜,李丹萍,陈华忠,郑丹,周益萍,陈葆国,石卫武,林荣海. 糖皮质激素治疗一例2019冠状病毒病(COVID-19)危重型患者炎症反应动态观察[J]. 浙江大学学报（医学版）, 2020, 49(2): 220-226.
[13] 李游江,胡瑛瑛,张晓东,喻员员,李斌,吴建国,吴英萍,夏肖萍,徐键. 七例2019冠状病毒病(COVID-19)普通型患者出院后病毒核酸随访结果[J]. 浙江大学学报（医学版）, 2020, 49(2): 270-274.
[14] 叶子奇,洪昀,吴秀华,洪东升,张燕芳,董曦浩,饶跃峰,卢晓阳. 一例肿瘤合并2019冠状病毒病(COVID-19)患者的治疗决策分析[J]. 浙江大学学报（医学版）, 2020, 49(2): 245-248.
[15] 丁叔波,俞世安,陈海君,张德和,徐叶进,朱丹,陈琨. 2019冠状病毒病(COVID-19)疑似患者多学科协作诊治分析[J]. 浙江大学学报（医学版）, 2020, 49(2): 209-214.