Department of Respiratory Disease, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
PLoS One. 2012;7(10):e47926. doi: 10.1371/journal.pone.0047926. Epub 2012 Oct 24.
The benefit of corticosteroids in community-acquired pneumonia (CAP) remains controversial. We did a meta-analysis to include all the randomized controlled trials (RCTs) which used corticosteroids as adjunctive therapy, to examine the benefits and risks of corticosteroids in the treatment of CAP in adults.
Databases including Pubmed, EMBASE, the Cochrane controlled trials register, and Google Scholar were searched to find relevant trials. Randomized and quasi-randomized trials of corticosteroids treatment in adult patients with CAP were included. Effects on primary outcome (mortality) and secondary outcomes (adverse events) were accessed in this meta-analysis.
Nine trials involving 1001 patients were included. Use of corticosteroids did not significantly reduce mortality (Peto odds ratio [OR] 0.62, 95% confidence interval [CI] 0.37-1.04; P = 0.07). In the subgroup analysis by the severity, a survival benefit was found among severe CAP patients (Peto OR 0.26, 95% CI 0.11-0.64; P = 0.003). In subgroup analysis by duration of corticosteroids treatment, significant reduced mortality was found among patients with prolonged corticosteroids treatment (Peto OR 0.51, 95% CI 0.26-0.97; P = 0.04; I(2) = 37%). Corticosteroids increased the risk of hyperglycemia (Peto OR 2.64, 95% CI 1.68-4.15; P<0.0001), but without increasing the risk of gastroduodenal bleeding (Peto OR 1.67, 95% CI 0.41-6.80; P = 0.47) and superinfection (Peto OR 1.36, 95% CI 0.65-2.84; P = 0.41).
Results from this meta-analysis did not suggest a benefit for corticosteroids treatment in patients with CAP. However, the use of corticosteroids was associated with improved mortality in severe CAP. In addition, prolonged corticosteroids therapy suggested a beneficial effect on mortality. These results should be confirmed by future adequately powered randomized trials.
皮质类固醇在社区获得性肺炎（CAP）中的益处仍存在争议。我们进行了一项荟萃分析，纳入了所有使用皮质类固醇作为辅助治疗的随机对照试验（RCT），以研究皮质类固醇治疗成人 CAP 的益处和风险。
检索 Pubmed、EMBASE、Cochrane 对照试验注册库和 Google Scholar 等数据库，以查找相关试验。纳入了皮质类固醇治疗成人 CAP 患者的随机和准随机试验。在这项荟萃分析中评估了对主要结局（死亡率）和次要结局（不良事件）的影响。
纳入了 9 项涉及 1001 名患者的试验。皮质类固醇的使用并未显著降低死亡率（Peto 比值比[OR]0.62，95%置信区间[CI]0.37-1.04；P=0.07）。在按严重程度进行的亚组分析中，在重症 CAP 患者中发现了生存获益（Peto OR 0.26，95% CI 0.11-0.64；P=0.003）。在按皮质类固醇治疗持续时间进行的亚组分析中，在接受延长皮质类固醇治疗的患者中，死亡率显著降低（Peto OR 0.51，95% CI 0.26-0.97；P=0.04；I(2)=37%）。皮质类固醇增加了高血糖的风险（Peto OR 2.64，95% CI 1.68-4.15；P<0.0001），但并未增加胃十二指肠出血的风险（Peto OR 1.67，95% CI 0.41-6.80；P=0.47）和继发感染的风险（Peto OR 1.36，95% CI 0.65-2.84；P=0.41）。
这项荟萃分析的结果表明，皮质类固醇治疗 CAP 患者无益。然而，皮质类固醇的使用与重症 CAP 患者的死亡率降低相关。此外，延长皮质类固醇治疗对死亡率有有益的影响。这些结果需要通过未来的充分有效的随机试验来证实。
