严重肺部感染的成年人用低剂量皮质类固醇:一篇评论
Romain Pirracchio1,2, Balasubramanian Venkatesh3,4, Matthieu Legrand1
1Department of Anesthesia and Perioperative Medicine, University of California San Francisco.
JAMA
|June 12, 2024
概括
低剂量皮质类固醇可显著降低COVID-19和细菌性肺炎等严重肺部感染的死亡率. 对于急性呼吸困难综合征或败血症患者来说,这些治疗提供了更好的结果.
科学领域:
- 危急护理医学
- 传染性疾病
- 肺病学
背景情况:
- 严重的肺部感染,包括COVID-19,肺炎和流感,是全球主要的成人死亡原因.
- 这些感染可能导致严重病患者的败血症和急性呼吸困难综合征 (ARDS),死亡率为30%至50%.
研究的目的:
- 评估低剂量皮质类固醇在严重肺部感染患者中降低死亡率的有效性.
- 评估低剂量皮质类固醇对患有败血症和ARDS等并发症的重症患者的影响.
主要方法:
- 随机临床试验和子组分析的系统审查和元分析.
- 包括涉及COVID-19患者,社区获得的肺炎,肺囊炎肺炎和ARDS的研究.
- 专注于低剂量皮质类固醇治疗方案 (每天≤400毫克的皮质素相当量).
主要成果:
- 低剂量皮质类固醇降低了严重COVID-19的28天死亡率 (23%与26%) 和严重社区获得的细菌性肺炎的30天死亡率 (10%与16%).
- 在患有肺囊肺炎的HIV患者 (13% vs 25%) 和ARDS患者 (34% vs 45%) 中观察到显著的死亡率降低.
- 一项小组分析显示,使用低剂量皮质类固醇治疗的社区获得性肺炎的死亡率降低了 (39% vs 51%).
结论:
- 低剂量皮质类固醇治疗与严重的COVID-19,社区获得的细菌性肺炎和肺囊性肺炎的死亡率降低有关.
- 这些药物可能有利于患有严重呼吸道感染并发症或ARDS的病人.
- 可能的副作用包括高血糖,胃肠道出血和二次感染.
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