Tassniyom S, Vasanawathana S, Chirawatkul A, Rojanasuphot S
Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Thailand.
Pediatrics. 1993 Jul;92(1):111-5.
Steroids are widely used in Thailand and other dengue-endemic countries to treat severe dengue shock syndrome. This study was designed to determine whether a single high dose of methylprednisolone will reduce mortality in children with dengue shock syndrome who did not respond to simple fluid and plasma replacement therapy.
A prospective, randomized, double-blind, controlled trial was conducted in two hospitals in Khon Kaen Thailand during June to September in 1987 and 1988. Sixty-three children with severe dengue shock syndrome were randomized into two groups; the first group received a single dose of methylprednisolone (30 mg/kg) and the second group received placebo.
There was no significant difference in mortality between the two groups (P = .63). The mortality rate was 12.5% (4/32) in the steroid group and 12.9% (4/31) in the group that received placebo. The sequelae at 2 weeks among treatment and control survivors were not significantly different. These two groups were comparable in age, sex, severity of illness, and duration of shock at the outset of the study. The two treatment groups were similar in subsequent hospital course as determined by maximum and minimum hematocrit level and bleeding severity. The numbers of patients in each group who had liver failure and evidence of disseminated intravascular clotting defect were also comparable. Complications such as occurrence of fever after shock, pneumonia, convulsion, cardiac arrest, pulmonary hemorrhage, and positive hemoculture were not significantly different in the treatment and control groups.
A single high dose of methylprednisolone does not reduce mortality in severe dengue shock syndrome which does not respond to conventional critical care.
在泰国及其他登革热流行国家，类固醇被广泛用于治疗严重登革热休克综合征。本研究旨在确定单次大剂量甲泼尼龙是否能降低对单纯液体和血浆置换疗法无反应的登革热休克综合征患儿的死亡率。
1987年6月至9月以及1988年6月至9月期间，在泰国孔敬府的两家医院进行了一项前瞻性、随机、双盲、对照试验。63名患有严重登革热休克综合征的儿童被随机分为两组；第一组接受单次剂量的甲泼尼龙（30mg/kg），第二组接受安慰剂。
两组之间的死亡率无显著差异（P = 0.63）。类固醇组的死亡率为12.5%（4/32），接受安慰剂组的死亡率为12.9%（4/31）。治疗组和对照组幸存者在2周时的后遗症无显著差异。在研究开始时，这两组在年龄、性别、疾病严重程度和休克持续时间方面具有可比性。根据最高和最低血细胞比容水平以及出血严重程度确定，两个治疗组在随后的住院过程中相似。每组中出现肝衰竭和弥散性血管内凝血缺陷证据的患者数量也具有可比性。休克后发热、肺炎、惊厥、心脏骤停、肺出血和血培养阳性等并发症在治疗组和对照组中无显著差异。
单次大剂量甲泼尼龙并不能降低对传统重症监护无反应的严重登革热休克综合征的死亡率。
