\u7ffb\u8bd1\uff1a\u9648\u71d5<\/p>\n\n\n\n
Comment & Response August 3, 2020<\/p>\n\n\n\n
In Reply<\/strong> In response to the concerns about survival bias and the findings regarding methylprednisolone in our Original Investigation,1<\/a><\/sup> we treated methylprednisolone use as a time-dependent variable with the Cox model in the same subgroup of 84 patients. The hazard ratio of methylprednisolone use for death was 0.52 (95% CI, 0.27-1.02; P<\/em>\u2009=\u2009.06), suggesting a trend toward a lower mortality.<\/p>\n\n\n\n \u57fa\u4e8e\u539f\u59cb\u8c03\u67e5\u4e2d\u5bf9\u751f\u5b58\u504f\u501a\u548c\u7532\u5f3a\u9f99\u7684\u8c03\u67e5\u7ed3\u679c\u7684\u62c5\u5fe7\uff0c\u6211\u4eec\u5728\u753184\u540d\u60a3\u8005\u7ec4\u6210\u7684\u76f8\u540c\u4e9a\u7ec4\u4e2d\u5e94\u7528COX\u6a21\u578b\u628a\u7532\u5f3a\u9f99\u7684\u4f7f\u7528\u770b\u4f5c\u65f6\u95f4\u4f9d\u8d56\u6027\u53d8\u5316\u3002\u7532\u5f3a\u9f99\u7684\u6b7b\u4ea1\u98ce\u9669\u6bd4\u662f0.52\uff0895%\u53ef\u4fe1\u533a\u95f4 0.27-1.02\uff1bP=0.06\uff09\uff0c\u6697\u793a\u7532\u5f3a\u9f99\u7684\u5e94\u7528\u6709\u964d\u4f4e\u6b7b\u4ea1\u7387\u7684\u8d8b\u52bf\u3002<\/p>\n\n\n\n Similarly, Ellsworth et al indicated that there was no difference in mortality between patients with acute respiratory distress syndrome who received methylprednisolone (23 of 50 [46%]) and those who did not (21 of 34 [62%]; 95% CI, \u201340% to 8%; P<\/em>\u2009=\u2009.23). There was a trend toward a better outcome, and the nonsignificant P<\/em> value might indicate that this subgroup analysis was underpowered. We followed up with patients to hospital discharge or death. We agree that the follow-up might be substantially shorter than needed to observe steroid adverse effects. As we discussed,1<\/a><\/sup> the findings in our cohort study should be interpreted with caution because of potential bias, residual confounding, and the small sample size.<\/p>\n\n\n\n \u76f8\u4f3c\u5730\uff0cEllsworth\u7b49\u4eba\u7814\u7a76\u8868\u660e\u5bf9\u4e8e\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81\u7684\u75c5\u4eba\u63a5\u53d7\uff0850\u4eba\u4e2d23\u4eba\uff0c46%\uff09\u548c\u672a\u63a5\u53d7(34\u4eba\u4e2d21\u4eba\uff0c62%)\u7532\u6cfc\u5c3c\u9f99\u6cbb\u7597\u7684\u75c5\u6b7b\u7387\u6ca1\u6709\u5dee\u5f02\uff0895%\u53ef\u4fe1\u533a\u95f4 -40%\u81f38%\uff1bP=0.23\uff09\u3002\u6211\u4eec\u503e\u5411\u4e8e\u66f4\u597d\u7684\u7814\u7a76\u7ed3\u679c\uff0c\u6ca1\u6709\u610f\u4e49\u7684P\u503c\u53ef\u80fd\u6697\u793a\u6b64\u4e9a\u7ec4\u4eba\u7fa4\u5206\u6790\u7f3a\u5c11\u6548\u529b\u3002\u6211\u4eec\u8ffd\u8e2a\u4e86\u51fa\u9662\u6216\u8005\u6b7b\u4ea1\u7684\u75c5\u4eba\u3002\u6211\u4eec\u8d5e\u6210\u89c2\u5bdf\u7c7b\u56fa\u9187\u7684\u526f\u4f5c\u7528\u7684\u5b9e\u8d28\u4e0a\u968f\u8bbf\u65f6\u95f4\u53ef\u80fd\u6bd4\u9700\u8981\u7684\u65f6\u95f4\u66f4\u77ed\u3002\u5982\u6211\u4eec\u8ba8\u8bba\u8fc7\u7684\u4e00\u6837\uff0c\u7531\u4e8e\u6f5c\u5728\u504f\u501a\u3001\u6b8b\u4f59\u7684\u6df7\u6742\u56e0\u7d20\u548c\u5c0f\u6837\u672c\u7684\u539f\u56e0\uff0c\u961f\u5217\u7814\u7a76\u7684\u7ed3\u679c\u5e94\u8be5\u88ab\u8c28\u614e\u89e3\u91ca\u3002<\/p>\n\n\n\n The role of corticosteroids in treating acute respiratory distress syndrome remains controversial and inconclusive.2<\/a><\/sup> For patients with coronavirus disease 2019 (COVID-19), there are insufficient data to recommend for or against the use of systemic corticosteroids.3<\/a><\/sup> Although our findings about methylprednisolone use contribute to the evidence base for the systemic corticosteroids in patients with COVID-19 and acute respiratory distress syndrome, well-designed double-blinded randomized clinical trials are needed.<\/p>\n\n\n\n \u7cd6\u76ae\u8d28\u6fc0\u7d20\u6cbb\u7597\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81\u7684\u4f5c\u7528\u4ecd\u662f\u6709\u4e89\u8bae\u548c\u4e0d\u786e\u5b9a\u7684\u3002\u5bf9\u4e8e\u65b0\u578b\u51a0\u72b6\u75c5\u6bd2\u80ba\u708e\u7684\u60a3\u8005\uff0c\u6ca1\u6709\u5145\u5206\u7684\u6570\u636e\u6765\u63a8\u8350\u6216\u53cd\u5bf9\u5168\u8eab\u6027\u5e94\u7528\u7cd6\u76ae\u8d28\u6fc0\u7d20\u3002\u5c3d\u7ba1\u6211\u4eec\u5bf9\u7532\u6cfc\u5c3c\u9f99\u7684\u7814\u7a76\u7ed3\u679c\u6709\u52a9\u4e8e\u4e3a\u65b0\u578b\u51a0\u72b6\u75c5\u6bd2\u80ba\u708e\u548c\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81\u60a3\u8005\u7684\u5168\u8eab\u6027\u7cd6\u76ae\u8d28\u6fc0\u7d20\u7684\u5e94\u7528\u63d0\u4f9b\u8bc1\u636e\u57fa\u7840\uff0c\u4f46\u662f\u9700\u8981\u8fdb\u4e00\u6b65\u5b9e\u65bd\u826f\u597d\u8bbe\u8ba1\u7684\u53cc\u76f2\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\u3002<\/p>\n","protected":false},"excerpt":{"rendered":" \u7ffb\u8bd1\uff1a\u9648\u71d5 Comment & Response August 3, 2 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19191"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19191"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19191\/revisions"}],"predecessor-version":[{"id":19194,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19191\/revisions\/19194"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19191"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19191"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19191"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}