摘要信息：目的 探讨西维来司他钠治疗对COVID-19相关急性呼吸窘迫综合征（ARDS）重症患者的生存率、氧合指数和感染血清标志物的影响。方法 回顾性纳入南方医科大学南方医院重症医学科中诊断为COVID-19相关ARDS患者，从医疗系统收集其入ICU 24 h内以及出院当天的数据，并收集入ICU后第1、3、7天的CRP、PCT、IL-6和氧合指数值。采用倾向性评分匹配将接受西维来司他钠治疗的患者与未接受治疗的患者进行匹配。采用Cox回归分析与线性回归分析探讨西维来司他钠给药与院内死亡率以及住院时间之间的相关性。结果 研究纳入199名COVID-19相关ARDS重症患者。经过倾向性评分匹配，接受西维来司他钠治疗的35名患者和没有接受西维来司他钠治疗的70名患者进行了匹配。西维来司他钠治疗与院内死亡率的降低（P=0.36）、ICU住院时间的延长（P=0.39）、住院时间（P=0.68）以及氧合指数的改善（P>0.05）无关。C反应蛋白和降钙素原没有发现明显的差异，但在西维来司他钠治疗组发现IL-6水平明显降低（P=0.016）。结论 西维来司他钠与COVID-19相关ARDS重症患者的死亡率和住院时间的减少没有相关性，但与血清IL-6水平的降低有关。

摘要信息：Purpose: This study aimed to evaluate the efficacy of sivelestat sodium on mortality, oxygenation index, and serum markers in patients with acute respiratory distress syndrome (ARDS) associated with Coronavirus Disease 2019 (COVID-19). Methods: A retrospective analysis was conducted on adult inpatients admitted to the Intensive Care Unit (ICU). The study compared clinical characteristics, laboratory indices, and mortality rates between patients treated with and without sivelestat sodium. Cox regression analysis was employed to assess the effect of sivelestat sodium on the risk of death, oxygenation index, and improvement of serum markers in patients with COVID-19-associated ARDS. Results: A total of 110 patients with COVID-19-associated ARDS were included, with 45 patients in the sivelestat group and 65 patients in the control group. The overall patient mortality rate was 69.1%, with 62.2% in the sivelestat group and 73.8% in the control group. After five days of treatment, the median change from baseline in the oxygenation index was 21 mmHg in the medicated group and −31 mmHg in the control group (p < 0.05). Analysis of the oxygenation index as a clinical endpoint event showed a significantly higher rate of improvement in the sivelestat group compared to the control group (57.8% vs. 38.5%, p < 0.05), and the odds of raising the oxygenation index after treatment were 2.05 times higher in the sivelestat group than in the control group (HR = 2.05, 95%CI: 1.02–4.15, p < 0.05). Among patients with a baseline oxygenation index < 200 mmHg, patients in the sivelestat group had an 86% lower risk of death compared to the control group (HR = 0.14, 95%CI: 0.02–0.81, p < 0.05). Conclusions: Sivelestat sodium demonstrated a significant improvement in the oxygenation index of patients with COVID-19-associated ARDS and was found to considerably reduce the risk of death in patients with a baseline oxygenation index of <200 mmHg.

摘要信息：目的：系统评价西维来司他钠治疗成人急性呼吸窘迫综合征（ARDS）患者的临床疗效。方法：检索PubMed、Embase、the Cochrane Library、中国知网、中国生物医学文献服务系统、万方数据知识服务平台，检索时间自数据库建库至2023年5月31日，收集西维来司他钠治疗成人ARDS的RCTs和队列研究，提取符合纳入和排除标准的文献资料。采用 RCTs 偏倚风险评估工具 RoB 2. 0 和非随机干预研究偏倚风险评估工具ROBINS-I进行文献质量评价。采用RevMan 5. 4和Stata 17. 0软件进行meta分析。结果　共纳入16篇文献，包括7篇RCTs和9篇队列研究，共9202例患者。meta分析结果显示，RCTs研究中，西维来司他钠治疗对ARDS患者 28~30 d 死亡率无影响（RR=0. 95，95%CI：0. 74~1. 21，P=0. 68）；但队列研究中，西维来司他钠治疗可降低 ARDS 患者 28~30 d 死亡率（RR=0. 86，95%CI：0. 81~0. 92，P<0. 0001）。西维来司他钠治疗可显著改善ARDS 患者的氧合指数（RCTs 中，MD=33. 08，95%CI：15. 43~50. 74，P<0. 000 01；队列研究中，RR=39. 74，95%CI：29. 81~49. 68，P<0. 000 01），缩短了轻中度 ARDS 患者的机械通气时间（RR=-2. 48，95%CI：-2. 91~-2. 05，P<0. 000 01）。Egger′s检验结果显示，纳入文献均不存在发表偏倚（P>0. 05）。结论：西维来司他钠治疗可改善轻中度ARDS患者的氧合指数，缩短机械通气时间，对28~30 d死亡率的影响有待进一步研究验证。

文章来源：2018 日本呼吸协会指南