肺部型硬化症中的皮质类固醇治疗:系统性审查
Shanthi Paramothayan1, Paul W Jones
1Division of Physiological Medicine, St George's Hospital Medical School, Cranmer Terrace, London SW17 ORE, England.
JAMA
|March 12, 2002
概括
口服皮质类固醇显著改善胸部X射线和肺部功能在肺部类固醇症. 然而,吸入性皮质类固醇显示不一致的结果,而类固醇的长期疾病修饰尚未被证明.
科学领域:
- 肺部病理学 肺部病理学
- 临床药理学 临床药理学
- 基于证据的医学基于证据的医学.
背景情况:
- 肺性类固醇症的治疗通常涉及皮质类固醇,以控制症状和预防肺损伤.
- 自发缓解是常见的,但疾病的严重程度会影响治疗决策和反应.
- 随机对照试验对于评估皮质类固醇在肺部类固醇病的疗效至关重要.
研究的目的:
- 评估口服和吸入类皮质类固醇对放射性发现,症状和肺部功能在肺部类固醇症的影响.
- 评估与肺部类固醇治疗相关的长期结果.
主要方法:
- 通过2001年12月对多个数据库 (MEDLINE,EMBASE,CINAHL,Cochrane) 进行了全面的文献搜索.
- 包括随机对照试验与对照组,成人参与者确诊的肺沙丘病,和皮质类固醇治疗至少8周.
- 使用Jadad评分进行质量评估,并与主要作者进行数据验证.
主要成果:
- 口服皮质类固醇在2期和3期疾病患者的胸部X射线检查结果 (Peto OR,2.54) 和肺功能 (强迫生命能力,扩散能力) 中显著改善.
- 吸入性皮质类固醇在小型,有限的研究中对胸部放射图没有显著影响,对肺功能和症状产生不一致的影响.
- 没有数据可用于评估皮质类固醇在停用后改变疾病的影响.
结论:
- 口服的皮质类固醇有效地改善了放射性结果,并为肺癌的肺功能提供了适度的收益.
- 由于研究规模较小和结果不一致,吸入性皮质类固醇的疗效仍然不确定.
- 目前的证据不支持用皮质类固醇治疗来改变长期 Sarcoidosis 的进展.
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