Sleasman J W, Hemenway C, Klein A S, Barrett D J
Department of Pediatrics, University of Florida College of Medicine, Gainesville.
Am J Dis Child. 1993 Jan;147(1):30-4. doi: 10.1001/archpedi.1993.02160250032012.
To determine if corticosteroids administered in addition to antimicrobials improve survival in children with acquired immunodeficiency syndrome and severe Pneumocystis carinii pneumonia (PCP).
Before-after, nonrandomized, case-comparison study.
Pediatric intensive care unit of a tertiary care teaching hospital in Florida.
Eleven children infected with the human immunodeficiency virus (HIV) with confirmed PCP.
Infants with HIV infection and acute respiratory failure due to PCP were studied sequentially.
The first seven infants were treated with antimicrobials alone while the next four received a 2-week course of methylprednisolone sodium succinate in addition to antimicrobials.
The two groups were similar with respect to age, route of HIV infection, stage of HIV disease, CD4 T-cell count, antiretroviral therapy, and respiratory parameters at intubation. All children treated with antimicrobials alone died while receiving mechanical ventilation. Survival of the children who received corticosteroid therapy was significantly improved (P < .05), and all were weaned from the ventilator.
Corticosteroids administered in addition to antimicrobials and supportive care improve the short-term survival of HIV-infected children who have acute respiratory failure due to PCP.
确定在使用抗菌药物的基础上加用皮质类固醇激素是否能提高获得性免疫缺陷综合征合并严重卡氏肺孢子虫肺炎（PCP）患儿的生存率。
前后对照、非随机病例对照研究。
佛罗里达州一家三级护理教学医院的儿科重症监护病房。
11例确诊为PCP的人类免疫缺陷病毒（HIV）感染儿童。
对因PCP导致急性呼吸衰竭的HIV感染婴儿进行序贯研究。
前7例婴儿仅接受抗菌药物治疗，后4例除抗菌药物外还接受了为期2周的甲泼尼龙琥珀酸钠治疗。
两组在年龄、HIV感染途径、HIV疾病分期、CD4 T细胞计数、抗逆转录病毒治疗及插管时的呼吸参数方面相似。仅接受抗菌药物治疗的所有儿童在接受机械通气时均死亡。接受皮质类固醇激素治疗的儿童生存率显著提高（P < 0.05），且均成功脱机。
在抗菌药物及支持治疗基础上加用皮质类固醇激素可提高因PCP导致急性呼吸衰竭的HIV感染儿童的短期生存率。
