Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Nagasaki University Infection Control and Education Centre, Nagasaki University Hospital, Nagasaki, Japan.
BMC Pulm Med. 2017 Dec 29;17(1):219. doi: 10.1186/s12890-017-0566-4.
There is conflicting evidence regarding the benefit of adjunctive corticosteroid therapy in patients with Mycoplasma pneumoniae pneumonia. We hypothesised that corticosteroid therapy could reduce mortality and length of stay (LOS) in such patients.
Adult patients with M. pneumoniae pneumonia from January 2010 to December 2013 were identified from the Japanese Diagnosis Procedure Combination inpatient database. The effects of low-dose and high-dose corticosteroid therapies on mortality, LOS, drug costs and hyperglycaemia requiring insulin treatment were evaluated using propensity score analyses.
Eligible patients (n = 2228) from 630 hospitals were divided into no-corticosteroid (n = 1829), low-dose corticosteroid (n = 267) and high-dose corticosteroid (n = 132) groups. The propensity score-matched pairs were generated from no-corticoid and low-dose corticoid groups (251 pairs), or no-corticoid and high-dose corticosteroid groups (120 pairs). Adjunctive corticosteroid therapy did not decrease 30-day mortality. In addition, both low-dose and high-dose corticosteroid therapies were associated with increases in LOS. Furthermore, hyperglycaemia requiring insulin treatment and drug cost increased with corticosteroid use.
Adjunctive treatment with low-dose or high-dose corticosteroids may not be beneficial in M. pneumoniae pneumonia.
关于肺炎支原体肺炎患者辅助皮质类固醇治疗的益处，存在相互矛盾的证据。我们假设皮质类固醇治疗可以降低此类患者的死亡率和住院时间（LOS）。
从 2010 年 1 月至 2013 年 12 月，从日本诊断程序组合住院患者数据库中确定了肺炎支原体肺炎的成年患者。使用倾向评分分析评估了低剂量和高剂量皮质类固醇治疗对死亡率、LOS、药物成本和需要胰岛素治疗的高血糖的影响。
从 630 家医院中选出符合条件的患者（n=2228）分为无皮质激素（n=1829）、低剂量皮质激素（n=267）和高剂量皮质激素（n=132）组。从无皮质激素和低剂量皮质激素组（251 对）或无皮质激素和高剂量皮质激素组（120 对）生成了倾向评分匹配对。辅助皮质类固醇治疗并未降低 30 天死亡率。此外，低剂量和高剂量皮质类固醇治疗均与 LOS 增加相关。此外，皮质类固醇的使用会导致需要胰岛素治疗的高血糖和药物成本增加。
低剂量或高剂量皮质类固醇辅助治疗可能对肺炎支原体肺炎无益。
