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【medical-news】严重肺炎：皮质激素的作用
The mortality rate in severe community- or hospital-acquired pneumonia is very high, ranging 20–50%. Despite advances in antimicrobial therapy and supportive measures, this rate has not changed in recent years, suggesting that other factors are also responsible for the poor outcome. An abnormal increase in the local and systemic inflammatory response is associated with poor outcome, and this occurs despite adequate antibiotic therapy.
There is evidence that acute administration of corticosteroids decreases the inflammatory response and might decrease mortality in severe pneumonia. This has been shown in one small randomised controlled study, terminated prematurely due to 0% mortality in the intervention arm. In addition, an experimental study showed that glucocorticosteroids decrease lung inflammatory response and lung bacterial burden, confirming the results obtained through in vitro investigations.
Although these results are promising and suggest a novel role of glucocorticosteroids in pneumonia, the inherent risks and potential side-effects of these drugs require further controlled clinical trials in order to better define the target population before their general use in clinical practice. Specifically, dosage, period of administration, titration, tapering and side-effects are some of the key questions that need to be investigated.
Eur Respir J 2008; 32:259-264 皮质激素在重症肺炎中的作用
社区或医院获得性重症肺炎的死亡率很高，约为20%-50%。尽管抗菌和支持疗法在进步，但今年来重症肺炎的死亡率仍未获改善，说明有其他因素参与了不良预后。局部和全身抗炎反应异常增加和预后不佳有关，这种情况即使在给予足够抗菌治疗时仍会发生。
因此，急性给予皮质激素可以抑制炎症反应，降低重症肺炎的病死率。这在一项小的随机对照实验中得到证实，该实验因干预可使病死率降为0%而过早结束。此外，实验研究证明糖皮质激素可以降低肺部炎症反应和肺部的细菌负荷，证实了体外实验的结果。
尽管这些结果使糖皮质激素有望在重症肺炎治疗中扮演一个全新的角色，但潜在的危险和副作用还需要进一步的临床对照实验证明，以便在临床推广之前确定其适用人群。特别是，用量，疗程，给药方法，减量和副作用仍是亟待解决的关键问题。
欧洲呼吸病学杂志，2008，32：259-264 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-03-25 05:14
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