McGee Steven, Hirschmann Jan
Department of Medicine, University of Washington, Seattle-Puget Sound Veterans Affairs Health Care System, Seattle, WA 98108, USA.
Arch Intern Med. 2008 May 26;168(10):1034-46. doi: 10.1001/archinte.168.10.1034.
Clinicians have generally avoided prescribing corticosteroids for active infection because of their known immunosuppressive effects and concern about long-term complications. We conducted a review of the published randomized, double-blind trials comparing corticosteroids and placebo in infections. Except in some trials of viral infections, sore throat, and cerebral cysticercosis, all patients also received active antimicrobial agents in addition to placebo or corticosteroids. For patients with bacterial meningitis, tuberculous meningitis, tuberculous pericarditis, severe typhoid fever, tetanus, or pneumocystis pneumonia with moderate to severe hypoxemia, treatment with corticosteroids improved patient survival (group 1 infections). For patients with bacterial arthritis, corticosteroids were also beneficial and reduced long-term disability (group 2 infections). For about a dozen other infections, corticosteroids significantly relieved symptoms (group 3 infections), and clinicians should consider using them if symptoms are substantial. Corticosteroids were harmful in 2 infections, viral hepatitis and cerebral malaria (group 5 infections). We conclude that corticosteroids are beneficial and safe for a wide variety of infections, although courses longer than 3 weeks should be withheld from patients with concomitant human immunodeficiency virus infection and low CD4 counts.
由于已知皮质类固醇具有免疫抑制作用且担心长期并发症，临床医生通常避免为活动性感染患者开具皮质类固醇药物。我们对已发表的比较皮质类固醇与安慰剂在感染中应用的随机双盲试验进行了综述。除了一些关于病毒感染、喉咙痛和脑囊尾蚴病的试验外，所有患者除了接受安慰剂或皮质类固醇外，还接受了有效的抗菌药物。对于患有细菌性脑膜炎、结核性脑膜炎、结核性心包炎、重症伤寒、破伤风或伴有中度至重度低氧血症的肺孢子菌肺炎的患者，使用皮质类固醇治疗可提高患者生存率（第1组感染）。对于患有细菌性关节炎的患者，皮质类固醇也有益处，并可减少长期残疾（第2组感染）。对于其他约十二种感染，皮质类固醇可显著缓解症状（第3组感染），如果症状严重，临床医生应考虑使用。皮质类固醇在两种感染中有害，即病毒性肝炎和脑型疟疾（第5组感染）。我们得出结论，皮质类固醇对多种感染有益且安全，尽管对于合并人类免疫缺陷病毒感染且CD4计数低的患者，应避免使用超过3周的疗程。
