Chen Li-Ping, Chen Jun-Hui, Chen Ying, Wu Chao, Yang Xiao-Hong
Department of Respiratory and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi 830001, China.
Department of Pharmacy, Sixth Affiliated Hospital of Xinjiang Medical University, Urumqi 830002, China.
World J Emerg Med. 2015;6(3):172-8. doi: 10.5847/wjem.j.1920-8642.2015.03.002.
Community-acquired pneumonia (CAP) is pneumonia acquired infectiously from normal social contact as opposed to being acquired during hospitalization. CAP is a leading cause of illness and death. This review aims to determine the efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia (CAP).
We searched randomized controlled trials (RCTs) from Pubmed, EMBASE, Cochrane Library, Chinese Journal Full-text Database, and Chinese Biomedical Literature Database to obtain the information by using steroids, glucocorticoids, cortisol, corticosteroids, community-acquired pneumonia and CAP as key words. The quality of RCTs was evaluated. A Meta-analysis was made using RevMan 5.0 provided by the Cochrance Collaboration.
Seven RCTs involving 944 patients were included in the meta-analysis. The mean length of hospital stay in glucocorticoids treatment group was significantly shorter than that in standard treatment group (WMD=-1.70, 95%CI 2.01-1.39, Z=10.81, P<0.00001). No statistically significant differences were found in the mortality rate (RR=0.77,95%CI 0.46-1.27, Z=1.03, P=0.30), the mean length of hospital stay in ICU (WMD=1.17, 95%CI 1.68-4.02, Z=0.81, P=0.42), the incidence of super infection (RR=1.32, 95%CI 0.66-2.63, Z=0.79, P=0.43), the incidence of hyperglycemia (RR=1.84, 95%CI 0.76-4.41, Z=1.36, P=0.17), the incidence of upper gastrointestinal bleeding (RR=1.98, 95%CI 0.37-10.59, Z=0.80, P=0.42) between the standard treatment group and the glucocorticoids treatment group.
The use of glucocorticoids in patients with community-acquired pneumonia can significantly shorten the duration of illness and have a favorable safety profile. However, it could not reduce the overall mortality.
社区获得性肺炎（CAP）是指在正常社交接触中感染获得的肺炎，而非在住院期间获得。CAP是疾病和死亡的主要原因。本综述旨在确定糖皮质激素治疗社区获得性肺炎（CAP）的疗效和安全性。
我们检索了来自PubMed、EMBASE、Cochrane图书馆、中国期刊全文数据库和中国生物医学文献数据库的随机对照试验（RCT），以“类固醇”“糖皮质激素”“皮质醇”“皮质类固醇”“社区获得性肺炎”和“CAP”作为关键词获取信息。对RCT的质量进行了评估。使用Cochrance协作网提供的RevMan 5.0进行Meta分析。
Meta分析纳入了7项涉及944例患者的RCT。糖皮质激素治疗组的平均住院时间显著短于标准治疗组（加权均数差=-1.70，95%置信区间2.01-1.39，Z=10.81，P<0.00001）。标准治疗组和糖皮质激素治疗组在死亡率（风险比=0.77，95%置信区间0.46-1.27，Z=1.03，P=0.30）、重症监护病房（ICU）平均住院时间（加权均数差=1.17，95%置信区间1.68-4.02，Z=0.81，P=0.42）、二重感染发生率（风险比=1.32，95%置信区间0.66-2.63，Z=0.79，P=0.43）、高血糖发生率（风险比=1.84，95%置信区间0.76-4.41，Z=1.36，P=0.17）、上消化道出血发生率（风险比=1.98，95%置信区间0.37-10.59，Z=0.80，P=0.42）方面未发现统计学显著差异。
在社区获得性肺炎患者中使用糖皮质激素可显著缩短病程，且安全性良好。然而，它不能降低总体死亡率。
