论文标题
细菌或病毒感染后的肺炎先于或随后发生辐射暴露 - 重新分析了较旧的放射性生物学数据，以及对低剂量放疗的影响，对COVID-19
Pneumonia after bacterial or viral infection preceded or followed by radiation exposure -- a reanalysis of older radiobiological data and implications for low dose radiotherapy for COVID-19 pneumonia
论文作者
论文摘要
目前，有14项正在进行的关于低剂量放疗（LDRT）的临床研究，用于肺炎。一个基本的假设是，大约1 Gy的辐射可有效缓解病毒性肺炎。然而，它的理由依赖于早期的人类病例系列或动物研究，主要是在抗生素前时代获得的，在抗生素前时代，未进行严格的统计分析。因此，尚不清楚这些早期数据是否支持此类假设。通过标准的统计生存模型，并基于系统文献综述，我们重新分析了14个放射生物学动物数据集，其中动物在细菌/病毒接种之前或之后大多接受了分馏的辐射剂量，并评估了各种健康终点（死亡率，肺炎发病率）。在大多数数据集中，吸收的剂量不超过7 Gy。考虑了各种不同的模型系统和类型的具有挑战性的感染。对于评估接种后辐射暴露的7项研究（与LDRT相关的Covid-19-19肺炎）是异质性的，其中2个研究表明与辐射暴露相关的死亡率显着增加（p <0.001），另一个研究显示出显着降低（p <0.001）。对于接种前的暴露，结果也是异质的，有6个数据集显示出与辐射暴露相关的死亡风险显着增加（P <0.01），而其他2个数据集则显示出死亡风险的显着降低（P <0.05）。总的来说，这些数据不能为与感染后辐射暴露有关的发病率或死亡率的降低提供明确的支持。对于感染前辐射暴露，效应方向的不一致使得该数据体难以解释。然而，必须谨慎对这些旧动物数据集的已发表报告中的证据保持谨慎。
Currently, there are 14 ongoing clinical studies on low dose radiotherapy (LDRT) for COVID-19 pneumonia. An underlying assumption is that irradiation of about 1 Gy is effective at ameliorating viral pneumonia. Its rationale, however, relies on early human case series or animal studies mostly obtained in the pre-antibiotic era, where rigorous statistical analyses were not performed. It therefore remains unclear whether those early data support such assumptions. With standard statistical survival models, and based on a systematic literature review, we re-analyzed 14 radiobiological animal datasets in which animals received mostly fractionated doses of radiation before or after bacterial/viral inoculation, and assessing various health endpoints (mortality, pneumonia morbidity). In most datasets absorbed doses did not exceed 7 Gy. Various different model systems and types of challenging infection are considered. For 7 studies that evaluated post-inoculation radiation exposure (more relevant to LDRT for COVID-19 pneumonia) the results are heterogeneous, with 2 studies showing a significant increase (p<0.001) and another showing a significant decrease (p<0.001) in mortality associated with radiation exposure. For pre-inoculation exposure the results are also heterogeneous, with 6 datasets showing a significant increase (p<0.01) in mortality risk associated with radiation exposure and the other 2 showing a significant decrease (p<0.05) in mortality risk. Collectively, these data do not provide clear support for reductions in morbidity or mortality associated with post-infection radiation exposure. For pre-infection radiation exposure the inconsistency of direction of effect makes this body of data difficult to interpret. Nevertheless, one must be cautious about adducing evidence from the published reports of these old animal datasets.
