单位:国家呼吸医学中心 中日友好医院 呼吸与危重症医学科
一、聚合酶抑制剂
二、蛋白酶抑制剂
三、卡莫司他
SARS-CoV-2通过ACE2受体进入宿主,并通过丝氨酸蛋白酶(TMPRSS2)激活刺突蛋白S[22]。卡莫司他通过抑制TMPRSS2阻止病毒进入宿主细胞。阿联酋ICU的一项回顾性研究发现卡莫司他治疗组患者机械通气率、升压药物使用率均显著低于对照组,卡莫司他治疗组患者的ICU病死率低于对照组(9.9% vs. 26.5%)[23]。由于这是一项回顾性研究,其循证医学证据强度较RCT研究弱,但也具有一定的提示作用,这也是目前较少的专门针对ICU患者的抗病毒药物研究。
四、单克隆抗体
COVID-19患者sIgG水平与病情严重程度密切相关,且具有时间依赖性,单克隆抗体通过直接结合SARS-CoV-2来阻止病毒进入靶细胞,而且竞争ACE2结合的单克隆抗体的抑制性优于竞争非ACE2结合的单克隆抗体[24]。
礼来公司的Bamlanivimab于2020年7月获得FDA紧急授权,但由于迅速的耐药报道,于2021年2月撤销了针对该药的紧急授权。Bamlanivimab+Etesevimab(中国科学院+礼来公司)联合方案发布后再次获得紧急授权。
但最近一项研究发现,所有的单克隆抗体均对原始毒株显示良好的抗病毒效应,部分单克隆抗体可对Omicron BA.2和BA.5产生较好的抗病毒效应,没有任何一个单克隆抗体可对Omicron BQ1.1或XBB产生抗病毒效应[19]。因此,当前流行的BQ1.1和XBB变异株具有更强的免疫逃逸能力。
五、恢复期血浆
六、NIH抗病毒治疗推荐
七、小结
参考文献
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