Jartti Tuomas, Lehtinen Pasi, Vanto Timo, Hartiala Jaakko, Vuorinen Tytti, Mäkelä Mika J, Ruuskanen Olli
Department of Pediatrics, Turku University Hospital, Turku, Finland.
Pediatr Infect Dis J. 2006 Jun;25(6):482-8. doi: 10.1097/01.inf.0000215226.69696.0c.
The role of systemic corticosteroids in the treatment of early childhood wheezing in children is not clear.
We sought to determine whether prednisolone is effective in rhinovirus-induced early wheezing.
We conducted a controlled trial comparing oral prednisolone (2 mg/kg per day in three divided doses for 3 days) with placebo in 78 hospitalized children (mean age, 1.1 year; standard deviation, 0.7) experiencing their first or second episode of wheezing induced by rhinovirus or respiratory syncytial virus. Mixed viral infections were excluded. Our primary end point was the time until the patient was ready for discharge; secondary end points included oxygen saturation during hospitalization, duration of symptoms, occurrence of relapses during the next 2 months and blood eosinophil counts at discharge and 2 weeks later.
In multivariate regression analysis, prednisolone did not influence the time until ready for discharge, but it decreased relapses during the subsequent 2-month period in rhinovirus-affected children (prednisolone versus placebo, 22% versus 56%; odds ratio, 19.06; 95% confidence interval, 2.52-144.03; P = 0.004) and in children with blood eosinophils > or = 0.2 x 10/L (respectively, 24% versus 71%; odds ratio, 10.57; 95% confidence interval, 1.99-56.22; P = 0.006). Rhinovirus-affected children had more blood eosinophils on admission (mean, 0.44 versus 0.086 x 10/L), had a higher prevalence of atopy (44% versus 8%) and were older (mean, 1.4 versus 0.9 years, P < 0.001 for all) than respiratory syncytial virus-infected children.
Prednisolone reduced relapses during a 2-month period after first episodes of wheezing associated with rhinovirus infection or blood eosinophils > or = 0.2 x 10/L.
全身用皮质类固醇在治疗儿童早期喘息中的作用尚不清楚。
我们试图确定泼尼松龙对鼻病毒诱发的早期喘息是否有效。
我们进行了一项对照试验，将78名住院儿童（平均年龄1.1岁；标准差0.7）分为两组，一组口服泼尼松龙（2毫克/千克/天，分三次服用，共3天），另一组服用安慰剂。这些儿童经历了由鼻病毒或呼吸道合胞病毒诱发的首次或第二次喘息发作，排除了混合病毒感染。我们的主要终点是患者准备出院的时间；次要终点包括住院期间的血氧饱和度、症状持续时间、接下来2个月内复发的情况以及出院时和2周后的血液嗜酸性粒细胞计数。
在多变量回归分析中，泼尼松龙对患者准备出院的时间没有影响，但它减少了鼻病毒感染儿童在随后2个月内的复发（泼尼松龙组与安慰剂组，分别为22%和56%；优势比，19.06；95%置信区间，2.52 - 144.03；P = 0.004），以及血液嗜酸性粒细胞≥0.2×10⁹/L的儿童中的复发（分别为24%和71%；优势比，10.57；95%置信区间，1.99 - 56.22；P = 0.006）。与呼吸道合胞病毒感染的儿童相比，鼻病毒感染的儿童入院时血液嗜酸性粒细胞更多（平均，0.44对0.086×10⁹/L），特应性患病率更高（44%对8%），年龄更大（平均年龄，1.4岁对0.9岁，所有比较P < 0.001）。
泼尼松龙减少了与鼻病毒感染或血液嗜酸性粒细胞≥0.2×10⁹/L相关的首次喘息发作后2个月内的复发。
