Chen Yuanjing, Li Ka, Pu Hongshan, Wu Taixiang
Department of Anesthesiology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, China, 610041.
Cochrane Database Syst Rev. 2011 Mar 16(3):CD007720. doi: 10.1002/14651858.CD007720.pub2.
Pneumonia is an acute inflammation of the lungs and treatments differ depending on the type and severity. Corticosteroids can influence immune regulation, carbohydrate metabolism, protein catabolism, electrolyte balance and stress response. However, the benefits of corticosteroids for patients with pneumonia remains unclear.
To assess the efficacy and safety of corticosteroids in the treatment of pneumonia.
We searched Cochrane Central Register of Controlled Clinical Trials (CENTRAL) (The Cochrane Library 2010, Issue 11) which contains the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE (1966 to December week 4, 2010), EMBASE (1974 to December 2010), the China National Knowledge Infrastructure (CNKI) (1978 to December 2010) and VIP (1986 to December 2010).
Randomised controlled trials (RCTs) assessing the effectiveness of corticosteroids for pneumonia.
Three review authors selected studies. We telephoned the trial authors to confirm the randomisation method used. We extracted and analysed the methodological details and data from the included studies.
We included six studies including 437 participants in the review. Two studies were of high methodological quality and three were of poor quality. All studies involved small numbers of participants. Two small studies provided weak evidence that corticosteroids did not significantly reduce mortality (Peto odds ratio (OR) 0.26; 95% CI 0.05 to 1.37), but accelerated the resolution of symptoms or time to clinical stability, and decreased the rate of relapse of the disease. Steroids can improve the oxygenation and reduce the need for mechanical ventilation in severe pneumonia. There was no significant difference between treatment groups with regards to the time to discharge from the intensive care unit (ICU). There were insufficient data to report the time to pneumonia resolution and admission to ICU. Typical adverse events associated with corticosteroid therapy were infrequent.
AUTHORS' CONCLUSIONS: In most patients with pneumonia, corticosteroids are generally beneficial for accelerating the time to resolution of symptoms. However, evidence from the included studies was not strong enough to make any recommendations.
肺炎是肺部的急性炎症，治疗方法因类型和严重程度而异。皮质类固醇可影响免疫调节、碳水化合物代谢、蛋白质分解代谢、电解质平衡和应激反应。然而，皮质类固醇对肺炎患者的益处仍不明确。
评估皮质类固醇治疗肺炎的疗效和安全性。
我们检索了Cochrane临床对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2010年第11期），其中包含Cochrane急性呼吸道感染小组的专业注册库、MEDLINE（1966年至2010年12月第4周）、EMBASE（1974年至2010年12月）、中国知网（CNKI）（1978年至2010年12月）和维普资讯（VIP）（1986年至2010年12月）。
评估皮质类固醇治疗肺炎有效性的随机对照试验（RCT）。
三位综述作者选择研究。我们致电试验作者以确认所使用的随机化方法。我们从纳入研究中提取并分析了方法学细节和数据。
我们纳入了六项研究，共437名参与者。两项研究方法学质量高，三项质量差。所有研究参与者数量均较少。两项小型研究提供了微弱证据，表明皮质类固醇并未显著降低死亡率（Peto比值比（OR）0.26；95%可信区间0.05至1.37），但加速了症状缓解或临床稳定时间，并降低了疾病复发率。类固醇可改善重度肺炎患者的氧合情况并减少机械通气需求。治疗组在从重症监护病房（ICU）出院时间方面无显著差异。报告肺炎缓解时间和入住ICU时间的数据不足。与皮质类固醇治疗相关的典型不良事件并不常见。
在大多数肺炎患者中，皮质类固醇通常有利于加速症状缓解时间。然而，纳入研究的证据不够充分，无法提出任何建议。
