Sayiner A, Aytemur Z A, Cirit M, Unsal I
Department of Chest Diseases, Ege University Medical School, Izmir, Turkey.
Chest. 2001 Mar;119(3):726-30. doi: 10.1378/chest.119.3.726.
This study aimed to compare the efficacies of 3-day and 10-day courses of methylprednisolone (MP) treatment in severe COPD exacerbations necessitating hospitalization for respiratory failure.
Prospective, randomized, single-blind study.
Tertiary-care center.
Thirty-six patients were included in the study and randomized into two groups: group 1 received MP, 0.5 mg/kg q6h for 3 days, and group 2 was administered the same dosage of MP for the first 3 days, after which it was tapered and terminated on the tenth day. There was no difference between the groups for age, baseline FEV(1), PaO(2), PaCO(2), and pH levels. One patient in group 1 who developed pneumothorax and one patient in group 2 who had steroid-related psychosis could not complete the study.
Both groups showed significant improvements in PaO(2) and FEV(1) levels, but these were more marked in group 2 (p = 0.012 and p = 0.019, respectively). There was a significant increase in FVC levels in group 2 only (p = 0.003). Group 2 also had a more marked improvement in dyspnea on exertion. There was no difference between the two groups with regards to other parameters, including pH, PaCO(2) levels, and other symptom scores. Six patients in group 1 and five patients in group 2 developed new exacerbations within the following 6 months. Hyperglycemia occurred in two patients in each group.
In severe COPD exacerbations, a 10-day course of steroid treatment is more effective than a 3-day course in improving the outcome, but has no benefit in reducing exacerbation rates.
本研究旨在比较甲基强的松龙（MP）治疗3天疗程与10天疗程对因呼吸衰竭而需住院治疗的重度慢性阻塞性肺疾病（COPD）急性加重期的疗效。
前瞻性、随机、单盲研究。
三级医疗中心。
36例患者纳入研究并随机分为两组：第1组接受MP，0.5mg/kg，每6小时1次，共3天；第2组在开始3天接受相同剂量的MP，之后逐渐减量并在第10天停药。两组患者在年龄、基线第一秒用力呼气容积（FEV₁）、动脉血氧分压（PaO₂）、动脉血二氧化碳分压（PaCO₂）及pH值水平方面无差异。第1组中有1例发生气胸的患者和第2组中有1例出现类固醇相关精神病的患者未能完成研究。
两组患者的PaO₂和FEV₁水平均有显著改善，但第2组更为明显（分别为p = 0.012和p = 0.019）。仅第2组的用力肺活量（FVC）水平有显著升高（p = 0.003）。第2组在运动时呼吸困难方面也有更明显的改善。两组在其他参数方面无差异，包括pH值、PaCO₂水平及其他症状评分。第1组有6例患者和第2组有5例患者在接下来的6个月内出现新的急性加重。每组各有2例患者发生高血糖。
在重度COPD急性加重期，类固醇治疗10天疗程在改善结局方面比3天疗程更有效，但在降低急性加重率方面并无益处。
