Sistek C J, Wordell C J, Hauptman S P
Department of Pharmacy, Thomas Jefferson University Hospital, Philadelphia, PA 19107.
Ann Pharmacother. 1992 Sep;26(9):1127-33. doi: 10.1177/106002809202600915.
To review published abstracts, case reports, and journal articles and evaluate data examining the use of systemic corticosteroids as adjuvant treatment for Pneumocystis carinii pneumonia (PCP) in patients with AIDS.
Computerized online databases, peer-reviewed journals from January 1986 through September 1991, and personal communication with a National Institutes of Health correspondent.
The authors identified 13 reports pertinent to this review. By author consensus, five studies were selected for analysis based on sample size, controlled study design, and clinical outcome measures. Recommendations of an expert panel from the National Institutes of Health and the University of California also are discussed.
Data are presented based on the methodologic strength of the studies reviewed. Studies are assessed on sample size, inclusion criteria, comparative cohort populations, specific patient outcome measures, and statistical analysis.
Results of the study analysis support the use of systemic corticosteroids as early adjunctive therapy for AIDS patients with moderate-to-severe PCP who have an initial arterial oxygen partial pressure of less than 70 mm Hg or an alveolar-arterial gradient greater than 35 mm Hg on room air. Improved outcomes included decreased mortality, respiratory failure, and deterioration of oxygenation. Data evaluated have shown that adjuvant corticosteroid therapy is most effective when initiated within 72 hours of beginning specific antipneumocystis therapy. A small, but sometimes significant, increased rate of infection in steroid-treated patients was noted.
Based on the literature reviewed, early systemic adjuvant corticosteroid therapy can benefit patients with moderate-to-severe AIDS-related PCP. The steroid regimen used in the largest controlled trial and recommended by the expert panel is prednisone 40 mg bid (days 1-5), then 40 mg/d (days 6-10), then 20 mg/d (days 1-21).
回顾已发表的摘要、病例报告和期刊文章，并评估有关系统性皮质类固醇作为艾滋病患者卡氏肺孢子虫肺炎（PCP）辅助治疗的数据。
计算机在线数据库、1986年1月至1991年9月的同行评审期刊，以及与国立卫生研究院一位通讯员的个人交流。
作者确定了13篇与本综述相关的报告。经作者一致同意，根据样本量、对照研究设计和临床结局指标，选择了5项研究进行分析。还讨论了国立卫生研究院和加利福尼亚大学专家小组的建议。
根据所综述研究的方法学优势呈现数据。对研究的评估基于样本量、纳入标准、比较队列人群、特定患者结局指标和统计分析。
研究分析结果支持将系统性皮质类固醇作为初始动脉血氧分压低于70mmHg或在室内空气中肺泡-动脉氧分压差大于35mmHg的中度至重度PCP艾滋病患者的早期辅助治疗。改善的结局包括死亡率降低、呼吸衰竭和氧合恶化。评估的数据表明，辅助性皮质类固醇治疗在开始特异性抗肺孢子虫治疗的72小时内启动时最为有效。注意到接受类固醇治疗的患者感染率有小幅但有时显著的增加。
基于所综述的文献，早期系统性辅助皮质类固醇治疗可使中度至重度艾滋病相关PCP患者受益。在最大规模的对照试验中使用并由专家小组推荐的类固醇治疗方案是泼尼松40mg，每日两次（第1 - 5天），然后40mg/d（第6 - 10天），然后20mg/d（第11 - 21天）。
