Cheng Ming, Pan Zhi-Yong, Yang Jiong, Gao Ya-Dong
Department of Pneumology.
Respir Care. 2014 Apr;59(4):557-63. doi: 10.4187/respcare.02758. Epub 2013 Sep 17.
The debate about the efficacy of corticosteroids in the treatment of severe community-acquired pneumonia (CAP) is still a longstanding dilemma. We performed a meta-analysis including 4 randomized controlled trials (RCTs) to evaluate the effect of corticosteroids on the treatment of severe CAP in adults.
We performed a systematic review of published and unpublished clinical trials. Databases, including PubMed, Embase, CINAHL, and Cochrane (from their establishment to July 2013), were searched for relevant articles. Only RCTs of corticosteroids as adjunctive therapy in adult patients with severe CAP were selected.
Four trials enrolling 264 patients with severe CAP were included. Use of corticosteroids significantly reduced hospital mortality compared with conventional therapy and placebo (Peto odds ratio = 0.39, 95% CI 0.17-0.90). The quality of the evidence underlying the pooled estimate of effect on hospital mortality was low, downgraded for inconsistency and imprecision.
On the basis of the current limited evidence, we suggest that, although corticosteroid therapy may reduce mortality and improve the prognosis of adult patients with severe CAP, the results should be interpreted with caution due to the instability of pooled estimates. Reliable treatment recommendations will be raised only when large sufficiently powered multi-center RCTs are conducted.
关于皮质类固醇在治疗重症社区获得性肺炎（CAP）中的疗效的争论仍是一个长期存在的难题。我们进行了一项荟萃分析，纳入4项随机对照试验（RCT），以评估皮质类固醇对成人重症CAP治疗的效果。
我们对已发表和未发表的临床试验进行了系统评价。检索了包括PubMed、Embase、CINAHL和Cochrane（从其建立至2013年7月）在内的数据库以查找相关文章。仅选择了将皮质类固醇作为成人重症CAP辅助治疗的RCT。
纳入了4项试验，共264例重症CAP患者。与传统治疗和安慰剂相比，使用皮质类固醇显著降低了医院死亡率（Peto比值比=0.39，95%可信区间0.17-0.90）。汇总估计对医院死亡率影响的证据质量较低，因不一致性和不精确性而被降级。
基于目前有限的证据，我们建议，尽管皮质类固醇治疗可能降低成人重症CAP患者的死亡率并改善预后，但由于汇总估计的不稳定性，结果应谨慎解读。只有进行大规模、有足够效力的多中心RCT，才会提出可靠的治疗建议。
