小剂量皮质类固醇对急性呼吸窘迫综合征患者的疗效：一项前瞻性观察研究。

Efficacy of low-dose corticosteroids in patients with acute respiratory distress syndrome: a prospective observational study.

作者信息

Zhang Ruoyang, Huang Xu, Lu Haining, Fan Guohui, Cai Ying, Tian Ye, Xia Jingen, Deng Wang, Wang Daoxin, Li Junlu, Wang Shilei, Xing Lihua, Liu Shaohua, Sun Tongwen, Wu Dawei, Zhan Qingyuan, Wang Chen

机构信息

China-Japan Friendship Hospital, Capital Medical University, Beijing, China.

Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital & National Clinical Research Center for Respiratory Diseases & Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.

出版信息

J Thorac Dis. 2022 Jul;14(7):2511-2521. doi: 10.21037/jtd-21-890.

DOI:10.21037/jtd-21-890

PMID:35928619

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9344422/

Abstract

BACKGROUND

There is still no agreement on whether corticosteroids can reduce mortality in patients with acute respiratory distress syndrome (ARDS). The aim of this study was to investigate the efficacy of low-dose corticosteroid administration in patients with ARDS.

METHODS

A prospective observational study of patients with ARDS in 17 hospitals in China was performed between March 2016 and February 2018. Propensity score matching was performed to adjust for differences in baseline characteristics between different groups. The effects of corticosteroids were assessed by using the Kaplan-Meier method and a multivariate Cox regression.

RESULTS

A total of 527 ARDS patients were enrolled in the study. Sixty-five patients (12.3%) were administered low-dose (methylprednisolone ≤1 mg·kg·d) corticosteroids. The median dose was equivalent to 0.67 (0.57-0.81) mg/kg methylprednisolone for a median duration of 10 days. The control group included 224 patients (42.5%) who had never receive corticosteroids. In the matched sample, the hospital mortality rates in the low-dose (n=40) and control groups (n=80) were 27.5% and 42.5% (P=0.110), respectively. The length of hospital stay was significantly longer in the low-dose corticosteroid group than in the control group (24.0 17.0, P=0.002), and the multivariate Cox regression analysis suggested that the low-dose group had a significantly lower risk of death than the control group (HR: 0.48; 95% CI: 0.24-0.97; P=0.040).

CONCLUSIONS

The administration of low-dose corticosteroids may reduce mortality in patients with ARDS.

摘要

背景

对于皮质类固醇能否降低急性呼吸窘迫综合征（ARDS）患者的死亡率，目前仍未达成共识。本研究旨在探讨低剂量皮质类固醇给药对ARDS患者的疗效。

方法

2016年3月至2018年2月期间，在中国17家医院对ARDS患者进行了一项前瞻性观察研究。采用倾向评分匹配法来调整不同组之间基线特征的差异。使用Kaplan-Meier法和多变量Cox回归分析评估皮质类固醇的效果。

结果

共有527例ARDS患者纳入本研究。65例患者（12.3%）接受了低剂量（甲泼尼龙≤1mg·kg·d）皮质类固醇治疗。甲泼尼龙的中位剂量相当于0.67（0.57 - 0.81）mg/kg，中位疗程为10天。对照组包括224例（42.5%）从未接受过皮质类固醇治疗的患者。在匹配样本中，低剂量组（n = 40）和对照组（n = 80）的医院死亡率分别为27.5%和42.5%（P = 0.110）。低剂量皮质类固醇组的住院时间显著长于对照组（24.0比17.0，P = 0.002），多变量Cox回归分析表明，低剂量组的死亡风险显著低于对照组（风险比：0.48；95%置信区间：0.24 - 0.97；P = 0.040）。