吸入性皮质类固醇添加到全身类固醇对COPD恶化结果的影响
Eyal Kleinhendler1, Noa Shopen1,2, Neta Cohen1,2
1Drs. Kleinhendler, Freund, Gershman, Unterman and Bar-Shai are affiliated with Division of Pulmonary Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; and Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
将吸入性皮质类固醇 (ICS) 添加到全身类固醇治疗COPD恶化并没有改善死亡率或住院等结果. 治疗应该是个性化的,因为ICS在这些急性事件中没有额外的好处.
科学领域:
- 肺部医学 肺部医学
- 临界护理医学 临界护理医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 慢性阻塞性肺病 (COPD) 恶化显著导致患者的发病率和死亡率.
- 吸入性皮质类固醇 (ICS) 用于长期的COPD治疗,但它们在恶化期间的益处,尤其是系统性类固醇,尚未得到充分证实.
研究的目的:
- 评估将ICS添加到全身类固醇治疗对COPD恶化期间结果的影响.
- 评估对住院时间,输管率和30天死亡率的影响.
主要方法:
- 追溯性观察性研究,对870名因COPD恶化而入院的患者进行研究 (2018年1月至2023年1月).
- 倾向性得分匹配被用来比较患者接受全身类固醇与ICS与仅服用全身类固醇之间的结果.
- 二次分析检查了基于乙氨基酸水平的子组.
主要成果:
- 在匹配后,354名患者接受了全身类固醇加上ICS,121名患者仅接受了全身类固醇;这些群体是可比的.
- 在30天死亡率 (7.1%对5.8%,P=0.63) 或二次结果 (输管,住院,再入院) 中没有发现显著差异.
- 乙氨基酸细胞数<150细胞/μL和高查尔森得分独立预测了一般队列中的30天死亡率.
结论:
- 在COPD恶化的情况下,将ICS添加到全身类固醇中,在这个队列中没有显示出额外的临床益处.
- 研究结果表明,目前的治疗策略可能不需要在恶化期间常规添加ICS.
- 需要个性化治疗方法和进一步的研究来澄清ICS在COPD恶化中的作用.
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