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[社区获得性肺炎中的皮质类固醇:2018年我们处于什么位置?]

[Corticosteroids in community acquired pneumonia: Where are we in 2018?].

作者信息

Soumagne T, Rabbat A

机构信息

Service de pneumologie et soins intensifs respiratoires, hôpital Cochin, hôpitaux universitaires, Paris centre, AP-HP, 75679 Paris cedex 14, France; Service de pneumologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France; Service de physiologie-explorations fonctionnelles, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France.

Service de pneumologie et soins intensifs respiratoires, hôpital Cochin, hôpitaux universitaires, Paris centre, AP-HP, 75679 Paris cedex 14, France.

出版信息

Rev Mal Respir. 2018 Oct;35(8):813-827. doi: 10.1016/j.rmr.2018.01.009. Epub 2018 Sep 12.

Abstract

Community-acquired pneumonia (CAP) is a common infectious disease and one of the main causes of mortality worldwide. Despite an improvement in management globally, mortality remains high especially in severe forms of CAP. Adequate early antibiotics remain the cornerstone of the treatment but adjuvant corticosteroid administration is being considered to counterbalance the systemic inflammatory reaction and modulate the immune response. In the last ten years, several clinical trials and meta-analyses have been conducted in severe and non-severe CAP to assess the efficacy of corticosteroids. The benefits on the duration of hospitalization and the time to clinical stability are quite small and early mortality does not seem to be improved. Corticosteroids should not, therefore, be used routinely in patients with CAP, even in severe cases. However, new therapeutic trials are currently underway.

摘要

社区获得性肺炎(CAP)是一种常见的传染病,也是全球主要的死亡原因之一。尽管全球范围内的治疗有所改善,但死亡率仍然很高,尤其是在重症CAP中。早期使用足够的抗生素仍然是治疗的基石,但正在考虑使用辅助性皮质类固醇来对抗全身炎症反应并调节免疫反应。在过去十年中,已经针对重症和非重症CAP进行了多项临床试验和荟萃分析,以评估皮质类固醇的疗效。其对住院时间和临床稳定时间的益处相当小,而且早期死亡率似乎并未得到改善。因此,即使在重症病例中,皮质类固醇也不应在CAP患者中常规使用。然而,目前新的治疗试验正在进行中。

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