Department of Integrated ICU, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Department of Integrated ICU, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Chest. 2016 Jan;149(1):209-19. doi: 10.1378/chest.15-1733. Epub 2016 Jan 6.
Corticosteroids are an option in the treatment of community-acquired pneumonia (CAP). However, the benefits and adverse effects of corticosteroids, especially in severe CAP, have not been well assessed.
PubMed, Embase, and Cochrane library databases from inception to May 2015 were searched. Randomized controlled trials (RCTs) and cohort studies that evaluated use of corticosteroids in adult patients with CAP were included. The quality of outcomes was evaluated using Grading of Recommendations Assessment, Development and Evaluation methodology. The Mantel-Haenszel method with random-effects modeling was used to calculate pooled relative risks (RRs) and 95% CIs.
Nine eligible RCTs (1,667 patients) and six cohort studies (4,095 patients) were identified. The mean corticosteroid dose and treatment duration were 30 mg/day methylprednisolone for 7 days. Corticosteroids did not have a statistically significant effect on mortality (RR, 0.72; 95% CI, 0.43-1.21; evidence rank, low) in patients with CAP and patients with severe CAP (RCTs: RR, 0.72; 95% CI, 0.43-1.21; evidence rank, low; cohort studies: RR, 1.00; 95% CI, 0.86-1.17 ). Corticosteroids treatment was associated with a decreased risk of ARDS (RR, 0.21; 95% CI, 0.08-0.59) and may reduce lengths of hospital and ICU stay, duration of IV antibiotic treatment, and time to clinical stability. Corticosteroids were not associated with increased rates of adverse events.
Short-term treatment with corticosteroids is safe and may reduce the risk of ARDS, shortening the length of the disease in patients with CAP.
皮质类固醇是治疗社区获得性肺炎（CAP）的一种选择。然而，皮质类固醇的益处和不良反应，特别是在重症 CAP 中的益处和不良反应，尚未得到很好的评估。
检索了从建库到 2015 年 5 月的 PubMed、Embase 和 Cochrane 图书馆数据库。纳入了评估皮质类固醇在成人 CAP 患者中应用的随机对照试验（RCT）和队列研究。使用推荐评估、制定与评估分级方法评估结局质量。采用 Mantel-Haenszel 法和随机效应模型计算汇总相对风险（RR）和 95%可信区间（CI）。
共纳入 9 项 RCT（1667 例患者）和 6 项队列研究（4095 例患者）。皮质类固醇的平均剂量和治疗持续时间为 30mg/d 甲泼尼龙，疗程 7 天。皮质类固醇对 CAP 患者和重症 CAP 患者的死亡率无统计学显著影响（RCT：RR，0.72；95%CI，0.43-1.21；证据等级，低；队列研究：RR，1.00；95%CI，0.86-1.17）。皮质类固醇治疗与急性呼吸窘迫综合征（ARDS）风险降低相关（RR，0.21；95%CI，0.08-0.59），可能缩短住院和 ICU 住院时间、静脉用抗生素治疗时间和达到临床稳定的时间。皮质类固醇治疗与不良反应发生率增加无关。
短期皮质类固醇治疗安全，可能降低 CAP 患者发生 ARDS 的风险，缩短疾病病程。
