Prina Elena, Ceccato Adrian, Torres Antoni
Servei de Pneumologia, Institut del Torax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
Seccion Neumologia, Hospital Nacional Alejandro Posadas, Palomar, Argentina.
Crit Care. 2016 Oct 1;20(1):267. doi: 10.1186/s13054-016-1442-y.
Despite improvements in the management of community-acquired pneumonia (CAP), morbidity and mortality are still high, especially in patients with more severe disease. Early and appropriate antibiotics remain the cornerstone in the treatment of CAP. However, two aspects seem to contribute to a worse outcome: an uncontrolled inflammatory reaction and an inadequate immune response. Adjuvant treatments, such as corticosteroids and intravenous immunoglobulins, have been proposed to counterbalance these effects. The use of corticosteroids in patients with severe CAP and a strong inflammatory reaction can reduce the time to clinical stability, the risk of treatment failure, and the risk of progression to acute respiratory distress syndrome. The administration of intravenous immunoglobulins seems to reinforce the immune response to the infection in particular in patients with inadequate levels of antibodies and when an enriched IgM preparation has been used; however, more studies are needed to determinate their impact on outcome and to define the population that will receive more benefit.
尽管社区获得性肺炎（CAP）的管理有所改善，但发病率和死亡率仍然很高，尤其是在病情较重的患者中。早期且恰当的抗生素仍然是CAP治疗的基石。然而，有两个方面似乎会导致更糟糕的结果：不受控制的炎症反应和免疫反应不足。已经提出使用辅助治疗，如皮质类固醇和静脉注射免疫球蛋白来抵消这些影响。在患有严重CAP且炎症反应强烈的患者中使用皮质类固醇可以缩短达到临床稳定的时间、降低治疗失败的风险以及进展为急性呼吸窘迫综合征的风险。静脉注射免疫球蛋白的给药似乎能增强对感染的免疫反应，特别是在抗体水平不足的患者以及使用了富含IgM制剂的情况下；然而，需要更多研究来确定它们对结局的影响，并确定能从其治疗中获益更多的人群。
