I-Dexamethasone: Ngaba izazinzulu zilufumene unyango lwe-COVID-19 eZigula kakhulu?

Idexamethasone enexabiso eliphantsi yehlisa ukufa ukuya kuthi ga kwisithathu kwizigulana ezisesibhedlele ezineengxaki zokuphefumla eziqatha ze-COVID-19

Izazinzulu ziye zathandabuza malunga nengqiqo yonyango olude lwe-corticosteroid kwi-Acute Respiratory Distress Syndrome (ARDS) ebangelwa Covid-19. Oku kufundwe nguVillar et al¹ kutshanje apho ababhali bathetha malunga nokuthandabuza okusekwe kubungqina obuvela kwizifundo ezine kuphela ezincinci ezibonisa ukuba izigulane azizuzi nto. Isidakamizwa impatho^2,3. Nangona kunjalo, izifundo ezivela eWuhan, China⁴ kunye ne-Ilay⁵ cebisa ukusetyenziswa kweesteroids ze-ARDS ezibangelwa yi-COVID-19. Ngoku ubungqina obuninzi obubambekayo buvela kulingo lwe-RECOVERY (Randomised Evaluation ye-COVID-19 theRAPY)⁶ ngokuthanda i-steroids ngokusebenzisa dexamethasone kunyango lwe kakhulu Izigulana ezigulayo ze-COVID-19 kulingo olungenamkhethe liqela lezazinzulu ezivela kwiYunivesithi yaseOxford, e-UK.

Bangaphezu kwe-11,500 abaguli ababhalise kwizibhedlele ze-NHS ezingaphezu kwe-175 e-UK ukuvavanya amayeza ahlukeneyo angeyobhayoloji kunye nebhayoloji kubandakanya i-hydroxychloroquine, amachiza alwa nentsholongwane kunye neTocilizumab. Ulingo obeluqhuba ukusukela ngoMatshi ka-2020 luye lwabona umntu ophumeleleyo ocacileyo kumachiza asetyenziswa kumlo ochasene ne-COVID-19 kwaye yidexamethasone. IHydroxychloroquine yayekwa ngenxa yokwanda kokubhubha kwabantu kunye neengxaki zentliziyo ngelixa amanye amachiza azanyiwe kwi-COVID-19 ngokunjalo, nangona esebenza kancinci ngokumalunga nolingo lwe-REVERY.

I-totali yezigulane ze-2104 zahlelwa ukuba zithole i-dexamethasone 6 mg kanye ngosuku (mhlawumbi ngomlomo okanye nge-injection ye-intravenous) kwiintsuku ze-10 kwaye zifaniswa nezigulane ze-4321 ezingazange zifumane ichiza. Phakathi kwezigulana ezingalifumananga ichiza, ukufa kweentsuku ezingama-28 kwakuphezulu kwabo bafuna ukungena komoya (41%), abaphakathi kwezo zigulana zazifuna ioksijini kuphela (25%), kwaye lisezantsi phakathi kwabo babengafuni nakuphi na ukuphefumla. ungenelelo (13%). I-Dexamethasone yehlise ukusweleka ngama-33% kwizigulane eziphefumlayo kwaye ngama-20% kwezinye izigulana ezifumana ioksijini kuphela. Nangona kunjalo, kwakungekho nzuzo phakathi kwezo zigulana zingadingi inkxaso yokuphefumla.

Amachiza eSteroidal nawo asetyenzisiwe kolunye uphononongo olubandakanya i-COVID-19. Kuphononongo olupapashwe nguLu et al⁷, Izigulane ze-151 kwizigulane ze-244 zanikwa indibaniselwano yamachiza e-antiviral kunye ne-adjuvant corticosteroid unyango (i-median hydrocortisone-equivalent dosage 200 [uluhlu lwe-100-800] mg / ngosuku). Kolu phononongo, izinga lokusinda eliphantsi (30%) libonwe kwiintsuku ze-28 kunye nezigulane ezifumana idosi ephezulu ye-steroids xa kuthelekiswa nabo bangazange (80%).

I-Dexamethasone sele isetyenziselwe ukunciphisa ukuvuvukala kuluhlu lwezinye iimeko. Kwimeko ye-COVID-19, i-dexamethasone ibonakala inciphisa ukudumba okubangelwa sisiphango se-cytokine esiba sisiphumo sosulelo lwe-COVID-19. Ke, eli chiza libonakala lilunyango olungummangaliso kwizigulana ezisengozini ye-COVID-19 ezifuna ukulaliswa esibhedlele. Irejimeni yonyango ye-dexamethasone ifikelela kwiintsuku ezili-10 kwaye ixabisa iipounds ezi-5 ngesigulane. Eli chiza liyafumaneka kwihlabathi kwaye linokusetyenziswa ukusindisa ubomi bezigulana ze-COVID-19 ukuya phambili.

Izifundo ezongezelelekileyo nge-dexamethasone kufuneka ziqhutywe kumazwe ahlukeneyo kunye nezizwe ngezizwe kwihlabathi liphela ukuseka ukusebenza kwayo kwi-COVID-19.

Ngaba abaphandi ekugqibeleni bafumene unyango olunexabiso eliphantsi, olufumaneka lula, olungummangaliso kwizigulana eziqatha ze-COVID-19 kwihlabathi liphela? Iqela leYunivesithi yaseOxford linika ingxelo yokuba i-dexamethasone enexabiso eliphantsi yehlisa ukufa ukuya kuthi ga kwi-33% kwizigulana ezisesibhedlele ezineengxaki ezinzulu zokuphefumla ze-COVID-19.

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Iingxelo:

1. Villar, J., Confalonieri M., et al 2020. Ingqiqo yoNyango lweCorticosteroid eLide kwi-Acute Respiratory Distress Syndrome ebangelwa yi-Coronavirus Disease 2019. Crit Care Explor. 2020 Epreli; 2(4): e0111. Ipapashwe kwi-intanethi nge-2020 ka-Epreli 29. DOI: https:///doi.org/10.1097/CCE.0000000000000111

2. URussell CD, uMillar JE, uBaillie JK. Ubungqina beklinikhi abuxhasi unyango lwe-corticosteroid yokonzakala kwemiphunga ka-2019-nCoV. I-Lancet. 2020; 395:473–475

3. UDelaney JW, uPinto R, uLong J, et al. Impembelelo yonyango lwe-corticosteroid kwisiphumo somkhuhlane A(H1N1pdm09)-enxulumene nesigulo esibalulekileyo. Ukhathalelo lweCrit. 2016; 20:75.

4. Shang L, Zhao J, Hu Y, et al. Ngokusetyenziswa kwe-corticosteroids ye-pneumonia ka-2019-nCoV. I-Lancet. 2020; 395:683–684

5. UNicastri E, Petrosillo N, uBartoli TA, kunye no-al. Iziko lesizwe lezifo ezosulelayo “L. Spallanzani”, IRCCS. Izindululo kulawulo lwezonyango lwe-COVID-19. Infect Dis Rep. 2020; 12:8543.

6. Ukukhutshwa kweNdaba kwiYunivesithi yaseOxford. 16 Juni 2020. Idexamethasone enexabiso eliphantsi yehlisa ukufa ukuya kutsho kwisithathu kwizigulana ezilaliswe esibhedlele ezineengxaki zokuphefumla ezimandundu ze-COVID-19. Iyafumaneka kwi-intanethi https://www.recoverytrial.net/files/recovery_dexamethasone_statement_160620_v2final.pdf Kufumaneka kwi-16 Juni 2020.

7. Lu, X., Chen, T., Wang, Y. et al. Unyango lwe-Adjuvant corticosteroid kwizigulana ezigula kakhulu ezine-COVID-19. Crit Care 24, 241 (2020). Ipapashwe nge-19 kuMeyi 2020. DOI: https://doi.org/10.1186/s13054-020-02964-w

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