Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.
Br J Clin Pharmacol. 2022 Jan;88(1):155-165. doi: 10.1111/bcp.14936. Epub 2021 Jul 22.
Corticosteroids are often prescribed to community-acquired pneumonia (CAP) patients, but the relationship with major cardiovascular events (MACEs) is unclear.
541 CAP patients were recruited (334 males, mean age 71.9 ± 16.2 years). High-sensitivity troponin T (hs-cTnT) was measured at admission, during the hospital stay and at discharge. MACE occurrence was registered during a long-term follow-up.
Overall, 318 patients (59%) showed hs-cTnT elevation >99th percentile (>0.014 μg/L). Age, heart failure and the increasing quintiles of hs-cTnT (hazard ratio [HR] 2.16, 95% confidence interval [CI] 1.82-2.58, P < .001) predicted MACEs. Among patients with hs-cTnT >0.014 μg/L at admission, 102 patients (31%) were on corticosteroids and showed lower hs-cTnT increase (P = .021), (NADPH) oxidase-2 (Nox2) activation (P = .005) and incidence of MACEs than untreated ones (HR 0.64, 95% CI 0.41-0.97, P = .038); no effect of corticosteroids on MACEs was observed in CAP patients with normal troponin. In vitro study showed that glucocorticoids have an antioxidant effect via downregulation of Nox2 activity.
The study provides evidence that corticosteroid use is associated with lower increase of hs-cTnT and incidence of MACEs in CAP patients.
皮质类固醇常被用于治疗社区获得性肺炎（CAP）患者，但与主要心血管事件（MACE）的关系尚不清楚。
共招募了 541 名 CAP 患者（334 名男性，平均年龄 71.9±16.2 岁）。入院时、住院期间和出院时检测高敏肌钙蛋白 T（hs-cTnT）。在长期随访期间登记 MACE 发生情况。
总体而言，318 名患者（59%）hs-cTnT 升高超过第 99 百分位数（>0.014μg/L）。年龄、心力衰竭和 hs-cTnT 递增五分位（风险比 [HR] 2.16，95%置信区间 [CI] 1.82-2.58，P<0.001）预测 MACE。入院时 hs-cTnT >0.014μg/L 的患者中，有 102 名（31%）正在使用皮质类固醇，hs-cTnT 升高幅度较低（P=0.021），（NADPH）氧化酶-2（Nox2）激活（P=0.005），MACE 发生率低于未治疗者（HR 0.64，95%CI 0.41-0.97，P=0.038）；在肌钙蛋白正常的 CAP 患者中，皮质类固醇对 MACE 无影响。体外研究表明，糖皮质激素通过下调 Nox2 活性具有抗氧化作用。
本研究表明，皮质类固醇的使用与 CAP 患者 hs-cTnT 升高幅度降低和 MACE 发生率降低相关。
