Hall C M, Louw S J, Joubert G
Respiratory Clinic, Groote Schuur Hospital.
S Afr Med J. 1995 Nov;85(11):1153-6.
The relative clinical efficacy of different types of intravenous glucocorticosteroids in acute severe asthma is not clear in published studies. We conducted a randomised prospective study of asthma unit admissions over a 3-month period. Therapy consisted of 4-hourly nebulised salbutamol, intravenous aminophylline and either intravenous hydrocortisone 200 mg 4-hourly or intravenous methylprednisolone 125 mg 12-hourly. Three hundred and eighty-six patients were admitted to the asthma unit. After exclusions, 191 patients were included in the analysis (hydrocortisone--91, methylprednisolone--100). The groups were comparable in respect of baseline data. The median time to maximum peak expiratory flow rate was 19 hours for hydrocortisone and 23 hours for methylprednisolone (median test, P = 0.21). Median duration of asthma unit stay was 30 hours for hydrocortisone and 36 hours for methylprednisolone (median test, P = 0.01). A similar difference was evident on comparison of the trial medications in patients who had previously been on oral maintenance steroids. We conclude that, at the dosages selected, hydrocortisone is more effective than methylprednisolone in acute severe asthma.
已发表的研究中，不同类型静脉注射糖皮质激素在急性重症哮喘中的相对临床疗效尚不明确。我们进行了一项为期3个月的哮喘病房入院患者随机前瞻性研究。治疗方案包括每4小时雾化吸入沙丁胺醇、静脉注射氨茶碱，以及每4小时静脉注射200 mg氢化可的松或每12小时静脉注射125 mg甲泼尼龙。386名患者入住哮喘病房。排除后，191名患者纳入分析（氢化可的松组91例，甲泼尼龙组100例）。两组基线数据具有可比性。氢化可的松组达到最大呼气峰值流速的中位时间为19小时，甲泼尼龙组为23小时（中位数检验，P = 0.21）。氢化可的松组在哮喘病房的中位住院时间为30小时，甲泼尼龙组为36小时（中位数检验，P = 0.01）。在比较之前接受口服维持性类固醇治疗的患者的试验药物时，也有类似差异。我们得出结论，在所选剂量下，氢化可的松在急性重症哮喘中比甲泼尼龙更有效。
