皮质类固醇治疗结核性胸膜炎的随机试验。
Randomised trial of corticosteroids in the treatment of tuberculous pleurisy.
作者信息
Galarza I, Cañete C, Granados A, Estopà R, Manresa F
机构信息
Servei de Pneumologia, Hospital Universitari de Bellvitge, Barcelona, Spain.
出版信息
Thorax. 1995 Dec;50(12):1305-7. doi: 10.1136/thx.50.12.1305.
BACKGROUND
Tuberculous pleurisy can result in pleural fibrosis, calcification and thickening. To prevent these complications, corticosteroids are frequently used in addition to antituberculous drugs; however, new therapeutic regimens can control the disease and minimise the sequelae, and there is no convincing evidence of the benefit of the use of corticosteroids as adjuvant therapy.
METHODS
Patients received isoniazid 5 mg/kg and rifampicin 10 mg/kg daily for six months. Additionally, they were randomly assigned to a double blind treatment with either prednisone (1 mg/kg/day for 15 days and then tapering off) or placebo during the first month of treatment. Different clinical, radiological, and functional parameters were evaluated to assess the effect of corticosteroids.
RESULTS
Fifty seven patients received prednisone and 60 placebo. At the end of the treatment the clinical outcome, the rate of reabsorption of the pleural fluid, the pleural sequelae, as well as lung capacity were similar in both groups.
CONCLUSIONS
Corticosteroids do not influence the clinical outcome or the development of long term pleural sequelae in tuberculous pleurisy.
背景
结核性胸膜炎可导致胸膜纤维化、钙化和增厚。为预防这些并发症，除抗结核药物外还经常使用皮质类固醇；然而，新的治疗方案可以控制疾病并使后遗症最小化，而且没有令人信服的证据表明使用皮质类固醇作为辅助治疗有益。
方法
患者每日接受5mg/kg异烟肼和10mg/kg利福平治疗六个月。此外，在治疗的第一个月，他们被随机分配接受泼尼松（1mg/kg/天，共15天，然后逐渐减量）或安慰剂的双盲治疗。评估不同的临床、放射学和功能参数以评估皮质类固醇的效果。
结果
57例患者接受泼尼松治疗，60例接受安慰剂治疗。治疗结束时，两组的临床结局、胸腔积液吸收速率、胸膜后遗症以及肺容量相似。
结论
皮质类固醇不影响结核性胸膜炎的临床结局或长期胸膜后遗症的发生。
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