Division of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
Int J Tuberc Lung Dis. 2011 May;15(5):687-92. doi: 10.5588/ijtld.10.0540.
Studies comparing corticosteroids in the management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are lacking.
To compare intravenous (IV) methylprednisolone (MP) followed by oral MP with IV hydrocortisone (HC) followed by oral prednisolone in patients with AECOPD.
Ninety-seven patients with AECOPD were randomly allocated to Group A (n = 50) or Group B (n = 47). Group A patients were administered HC 200 mg 6 hourly until discharge, followed by prednisolone 0.75 mg/kg/day for 2 weeks; Group B patients were administered IV MP (125 mg bolus, followed by 40 mg 6 hourly) and then oral MP 0.6 mg/kg/day for 2 weeks. Clinical variables, peak expiratory flow (PEF) and forced expiratory volume in 1 second (FEV(1)) were assessed until discharge and again 2 weeks after discharge.
Baseline characteristics were comparable. Mortality, need for mechanical ventilation and acute exacerbation within 2 weeks of discharge were not significantly different between the two groups. However, at 2 weeks, Group B showed significant improvement over Group A in FEV(1) and PEF.
This study suggests that in AECOPD, IV MP followed by oral MP produced greater improvement in FEV(1) and PEF than IV HC followed by oral prednisolone, although there were no differences in need for ventilator support or in recurrence of exacerbation.
缺乏比较皮质类固醇治疗慢性阻塞性肺疾病急性加重（AECOPD）的研究。
比较静脉注射（IV）甲泼尼龙（MP）序贯口服 MP 与静脉注射氢化可的松（HC）序贯口服泼尼松龙在 AECOPD 患者中的疗效。
97 例 AECOPD 患者随机分为 A 组（n = 50）和 B 组（n = 47）。A 组患者接受 HC 200mg，每 6 小时 1 次，直至出院，然后给予泼尼松龙 0.75mg/kg/天，共 2 周；B 组患者接受 IV MP（125mg 推注，然后 6 小时 1 次 40mg），然后口服 MP 0.6mg/kg/天，共 2 周。评估临床变量、呼气峰流速（PEF）和 1 秒用力呼气量（FEV1），直至出院，出院后 2 周再次评估。
两组患者的基线特征相当。两组间死亡率、机械通气需求和出院后 2 周内急性加重无显著差异。然而，出院后 2 周，B 组 FEV1 和 PEF 较 A 组显著改善。
本研究表明，在 AECOPD 中，IV MP 序贯口服 MP 比 IV HC 序贯口服泼尼松龙在 FEV1 和 PEF 方面的改善更显著，尽管在呼吸机支持需求或加重复发方面无差异。
