设为首页 加入收藏

科学研究

科室电话:
010-69159179
当前位置:科学研究 > 科研动态 > 浏览文章

皮质激素治疗伴随强烈炎症反应的重症社区获得性肺炎

2015年03月09日 作者:佚名 编辑:ydq 浏览次数:

jama.jpg

Effect of Corticosteroids on Treatment Failure Among Hospitalized Patients With Severe Community-Acquired Pneumonia and High Inflammatory Response: A Randomized Clinical Trial

Antoni Torres,MD, PhD; Oriol Sibila,MD, PhD; Miquel Ferrer,MD, PhD; Eva Polverino,MD, PhD; Rosario Menendez,MD, PhD; Josep Mensa,MD, PhD; Albert Gabarr.s, MSc; Jacobo Sellar.s,MD, PhD; Marcos I.Restrepo,MD, MSc; Antonio Anzueto,MD, PhD; Michael S. Niederman,MD;Carles Agust.,MD,PhD

JAMA. 2015;313(7):677-686. doi:10.1001/jama.2015.88

 

重要性(IMPORTANCE)

对于重症社区获得性肺炎患者,治疗失败与过度炎症反应和预后不良相关。皮质激素能够调节这些患者释放的细胞因子,但是这种辅助治疗的益处尚存在争论。

In patients with severe community-acquired pneumonia, treatment failure is associated with excessive inflammatory response and worse outcomes. Corticosteroids may modulate cytokine release in these patients, but the benefit of this adjunctive therapy remains controversial.

 

目的(OBJECTIVE)

评价皮质激素治疗对伴强烈炎症反应的重症社区获得性肺炎患者的影响。

To assess the effect of corticosteroids in patients with severe community acquired pneumonia and high associated inflammatory response.

 

设计,场所及研究对象(DESIGN, SETTING, AND PARTICIPANTS)

在西班牙3个教学医院进行的多中心,随机,双盲,安慰剂对照试验,入选伴有强烈炎症反应的重症社区获得性肺炎患者。强烈炎症反应定义为入院时C反应蛋白高于150 mg/L20047月开始入选患者,随访至20122月结束。

Multicenter, randomized, double-blind, placebo-controlled trial conducted in 3 Spanish teaching hospitals involving patients with both severe community-acquired pneumonia and a high inflammatory response, which was defined as a level of C-reactive protein greater than 150mg/L at admission. Patients were recruited and followed up from June 2004 through February 2012.

 

干预

 

措施(INTERVENTIONS)

患者随机分组,入院36小时内分别接受静脉甲基强的松龙0.5 mg/kg q12h (n = 61)或安慰剂(n = 59),疗程共5天。

Patients were randomized to receive either an intravenous bolus of 0.5mg/kg per 12 hours of methylprednisolone (n = 61) or placebo (n = 59) for 5 days started within 36 hours of hospital admission.

 

主要预后及测定指标(MAIN OUTCOMES AND MEASURES)

主要预后指标为治疗失败(早期治疗失败综合指标,定义为治疗72小时内[1]临床病情恶化如发生休克,[2]入院后需要有创机械通气,或[3]死亡;或晚期治疗失败,定义为治疗开始72小时至120小时之间[1]影像学进展,[2]重度呼吸功能衰竭持续,[3]发生休克,[4]入院后需要有创机械通气;或早期及晚期治疗失败)。住院病死率为次要预后指标,同时评价不良事件。

The primary outcome was treatment failure (composite outcome of early treatment failure defined as [1] clinical deterioration indicated by development of shock, [2] need for invasive mechanical ventilation not present at baseline, or [3] death within 72 hours of treatment; or composite outcome of late treatment failure defined as [1] radiographic progression, [2] persistence of severe respiratory failure, [3] development of shock, [4] need for invasive mechanical ventilation not present at baseline, or [5] death between 72 hours and 120 hours after treatment initiation; or both early and late treatment failure). In-hospital mortality was a secondary outcome and adverse events were assessed.

 

结果(RESULTS)

甲基强的松龙组患者治疗失败率较低(8名患者[13%],安慰剂组18[31%]p = 0.02),组间差异18% (95%CI 3 - 12%)。皮质激素治疗降低治疗失败风险(OR 0.34, 95%CI, 0.14 - 0.87, p = 0.02)。两组间住院病死率并无差异(甲基强的松龙组6例患者[10%] vs 安慰剂组9例患者[15%]p = 0.37),组间差异5% (95%CI -6 - 17%)。甲基强的松龙组11例患者(18%)发生高血糖,安慰剂组7(12%) (p = 0.34)

There was less treatment failure among patients from the methylprednisolone group (8 patients [13%]) compared with the placebo group (18 patients [31%]) (P = .02), with a difference between groups of 18%(95%CI, 3%to 32%). Corticosteroid treatment reduced the risk of treatment failure (odds ratio, 0.34 [95%CI, 0.14 to 0.87]; P = .02). In-hospital mortality did not differ between the 2 groups (6 patients [10%] in the methylprednisolone group vs 9 patients [15%] in the placebo group; P = .37); the difference between groups was 5%(95%CI, −6%to 17%). Hyperglycemia occurred in 11 patients (18%) in the methylprednisolone group and in 7 patients (12%) in the placebo group (P = .34).

 

 

结论和临床意义(CONCLUSIONS AND RELEVANCE)

对于伴有强烈炎症反应的重症社区获得性肺炎患者,与安慰剂对照相比,急性期使用甲基强的松龙减少治疗失败。如果能够重复,这些发现支持在这一患者人群将皮质激素作为辅助治疗。

Among patients with severe community-acquired pneumonia and high initial inflammatory response, the acute use of methylprednisolone compared with placebo decreased treatment failure. If replicated, these findings would support the use of corticosteroids as adjunctive treatment in this clinical population.

TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00908713

 

 

 以下是对 [激素治疗重症社区获得性肺炎] 的评论,总共:0条评论

地址:(东院)北京市东城区帅府园一号,100730;(西院)北京市西城区大木仓胡同41号,100032

技术支持:联创高科

京ICP备14061090号 2014-2016 All Rights Reserved © 北京协和医院急诊医学科