系统性皮质类固醇用于治疗呼吸系统疾病:少是更好,但...在现实生活中,何时以及如何实现?
Andrea S Melani1, Sara Croce2, Lucia Cassai2
1Clinica di Malattie Apparato Respiratorio, Dipartimento Scienze Mediche, Chirurgiche e Neuroscienze, Università degli Studi di Siena, Azienda Ospedaliero-Universitaria Senese, Policlinico S.Maria alle Scotte, Viale Bracci, 53100, Siena, Italy. a.melani@ao-siena.toscana.it.
Pulmonary therapy
|June 25, 2023
概括
系统性皮质类固醇 (CSs) 是肺病学中重要的抗炎药物,但携带诸如上腺功能衰竭等风险. 尽量减少CS剂量和持续时间对于呼吸道疾病的安全治疗至关重要.
科学领域:
- 肺部病理学 肺部病理学
- 药理学 药理学是指药理学的学科.
- 内分泌学 在内分泌学.
背景情况:
- 系统性皮质类固醇 (CSs) 具有强大的抗炎性质,使其在治疗各种呼吸道疾病中至关重要.
- 尽管CS具有有效性,但与显著的副作用有关,包括下丘脑-垂体-上腺 (HPA) 轴抑制和潜在的上腺功能不充分.
- 尽量减少CS剂量和持续时间是药理学研究的一个关键挑战,以确保安全有效的治疗.
研究的目的:
- 审查CS在呼吸道疾病中的使用指示.
- 分析最佳的CS类型,剂量和治疗持续时间,强调最小化.
- 讨论安全的CS缩小和管理上腺功能不全的策略.
主要方法:
- 这篇叙述性综述综合了关于在呼吸系统疾病中使用皮质类固醇的现有文献.
- 审查了在喘,COPD,COVID-19肺炎,ARDS和间歇性肺部疾病等疾病中对CS处方的当前指南.
- 分析了关于CS剂量,治疗长度和对上腺功能不充分的监测的数据.
主要成果:
- 慢性CS治疗与预后不佳有关,但在严重的喘,COPD和间歇性肺部疾病中仍然很常见.
- 指导方针建议在COVID-19肺炎,喘和COPD恶化中短期使用甲基普雷迪尼索隆 (20-40毫克/天).
- 短暂的CS疗程 (<10-14天) 可以突然停止,并监测上腺功能不充分;较长的疗程需要逐渐逐渐减少和HPA轴评估.
结论:
- 在肺病学中使用安全的皮质类固醇需要尽量减少剂量和持续时间.
- 仔细监测和评估上腺功能缺陷至关重要,特别是在长时间或高剂量CS治疗后.
- 逐渐的逐渐缩小和HPA轴的评估支持在指示时安全的CS提取.
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