Sang Julie, Motes Arunee, Nugent Kenneth
Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA.
J Community Hosp Intern Med Perspect. 2025 Mar 7;15(2):35-47. doi: 10.55729/2000-9666.1453. eCollection 2025.
Tuberculous (TB) pleural effusions and pericarditis are relatively common extrapulmonary complications associated with this infection. Corticosteroids have been studied with standard antituberculous medications in the management of tuberculous pleural effusion and pericarditis due to their anti-inflammatory effect and their potential to modulate host inflammatory responses. However, current studies have reported conflicting results and inconsistent benefits of adjunctive corticosteroids with TB drug treatment. In TB pleural effusion, corticosteroids have reduced the duration of symptoms and accelerated the reabsorption of pleural fluid, but their long-term benefits, such as less residual pleural thickening and improved lung function, remain inconsistent across studies. Similarly, studies on TB pericarditis have shown mixed results, with some indicating faster resolution of symptoms and reduced incidence of constrictive pericarditis, while others found no difference in mortality and other complications. Although corticosteroids may offer some benefits in managing pleural or pericardial tuberculosis, the current evidence is not sufficient to support their routine use. Key questions include the optimal corticosteroid dosage, the timing of corticosteroid initiation during the infection, and the duration of corticosteroid treatment. More research is needed to determine which cases benefit from corticosteroids as adjunctive therapy in patients with pleural and pericardial tuberculosis.
结核性（TB）胸腔积液和心包炎是与这种感染相关的相对常见的肺外并发症。由于其抗炎作用及其调节宿主炎症反应的潜力，皮质类固醇已与标准抗结核药物一起用于治疗结核性胸腔积液和心包炎。然而，目前的研究报告了辅助使用皮质类固醇与抗结核药物治疗的结果相互矛盾且益处不一致。在结核性胸腔积液中，皮质类固醇缩短了症状持续时间并加速了胸腔积液的重吸收，但它们的长期益处，如较少的残留胸膜增厚和改善的肺功能，在各研究中仍不一致。同样，关于结核性心包炎的研究结果也参差不齐，一些研究表明症状缓解更快且缩窄性心包炎的发生率降低，而另一些研究则发现死亡率和其他并发症没有差异。虽然皮质类固醇在治疗胸膜或心包结核方面可能有一些益处，但目前的证据不足以支持其常规使用。关键问题包括最佳皮质类固醇剂量、感染期间开始使用皮质类固醇的时机以及皮质类固醇治疗的持续时间。需要更多的研究来确定哪些病例在胸膜和心包结核患者中作为辅助治疗受益于皮质类固醇。
