Senat M V
Service de Gynécologie-Obstétrique, CHI Poissy-Saint-Germain, 10, rue du Champ-Gaillard, 78300 Poissy.
J Gynecol Obstet Biol Reprod (Paris). 2002 Nov;31(7 Suppl):5S105-13.
Fifteen randomized studies in Crowley's analysis compared a group of patients receiving, a single course of steroids versus placebo between 24 and 34 weeks of gestation. It clearly demonstrated the benefit of a single course of steroids in the prevention of the prematurity-related complications with a decrease in neonatal mortality, a decrease in the incidence of respiratory distress syndrome, a reduction in the incidence of intraventricular haemorrhage and a reduction in necrotizing enterocolitis (NP 1). Because only bethamethasone has proved its efficiency in the reduction of neonatal mortality (NP 2) and antenatal exposition to betamethasone is associated with a decrease in the risk of periventricular leukomalacia in children born prematurely (NP 3) it seems preferable to use betamethasone rather than dexamethasone. Antenatal administration of repeated courses compared with single course of steroids improves fetal lung function with a decrease of RDS notably if the children is born before 28 weeks of gestation (NP 2) but numerous animal studies reported adverse effects of repeated courses. Several studies in women having received of repeated courses steroids report a decrease in birth weight and head circumference at birth but with a 3 years follow up similar to that of children exposed to a single course (NP 3). In conclusion the benefit of a single course of steroids is indisputable for the prevention of the prematurity-related complications but there is today a strong concern about the benefit/risk ratio in relation to the prescription of repeated courses of steroids.
在克劳利的分析中，有15项随机研究比较了一组在妊娠24至34周期间接受单疗程类固醇治疗的患者与接受安慰剂治疗的患者。研究清楚地表明了单疗程类固醇在预防早产相关并发症方面的益处，包括新生儿死亡率降低、呼吸窘迫综合征发病率降低、脑室内出血发病率降低以及坏死性小肠结肠炎发病率降低（证据等级1）。由于只有倍他米松已被证明在降低新生儿死亡率方面有效（证据等级2），并且产前使用倍他米松与早产儿童脑室周围白质软化风险降低有关（证据等级3），因此似乎更宜使用倍他米松而非地塞米松。与单疗程类固醇相比，产前重复疗程给药可改善胎儿肺功能，尤其是在妊娠28周前出生的儿童中，呼吸窘迫综合征的发病率显著降低（证据等级2），但大量动物研究报告了重复疗程的不良反应。几项针对接受重复疗程类固醇治疗的女性的研究报告称，出生时体重和头围有所下降，但在3年的随访中，与接受单疗程治疗的儿童相似（证据等级3）。总之，单疗程类固醇在预防早产相关并发症方面的益处是无可争议的，但目前人们对重复疗程类固醇处方的效益风险比深感担忧。
