Dooley D P, Carpenter J L, Rademacher S
Department of Medicine, Brooke Army Medical Center, Fort Sam Houston 78234-6200, USA.
Clin Infect Dis. 1997 Oct;25(4):872-87. doi: 10.1086/515543.
An extensive, although largely forgotten, literature addresses the utility of adjunctive corticosteroid therapy in the management of tuberculosis. Corticosteroid therapy probably improves neurological outcomes of, and decreases mortality due to, tuberculous meningitis of moderate severity. Although therapy for tuberculous pericarditis is simplified (with less need for operative intervention) by adjunctive corticosteroid administration and there are fewer deaths, the incidence of subsequent constriction is not changed. The signs and symptoms of typical reactivation tuberculous pneumonia, tuberculous pleurisy, and probably primary tuberculous disease (with lymphadenopathy) seem to decrease rapidly with corticosteroid therapy, although no differences in final outcomes have been observed. Corticosteroid regimens used in most studies varied greatly in duration and dosage and generally caused significant side effects. Corticosteroids do not appear to diminish the efficacy of adequate antimycobacterial therapy. Adjunctive corticosteroid therapy appears to offer significant short-term but (other than for tuberculous meningitis and effusive pericarditis) minimal long-term benefit for patients with tuberculosis.
有大量关于辅助性皮质类固醇疗法在结核病治疗中的效用的文献，尽管这些文献在很大程度上已被遗忘。皮质类固醇疗法可能会改善中度严重结核性脑膜炎的神经学预后并降低其死亡率。尽管辅助使用皮质类固醇可简化结核性心包炎的治疗（减少手术干预的需求）且死亡人数减少，但随后发生缩窄的发生率并未改变。典型的复发性结核性肺炎、结核性胸膜炎以及可能的原发性结核疾病（伴有淋巴结病）的体征和症状似乎在使用皮质类固醇治疗后迅速减轻，尽管尚未观察到最终预后的差异。大多数研究中使用的皮质类固醇治疗方案在疗程和剂量方面差异很大，且通常会引起显著的副作用。皮质类固醇似乎不会降低充分抗分枝杆菌治疗的疗效。辅助性皮质类固醇疗法似乎能为结核病患者带来显著的短期益处，但（除结核性脑膜炎和渗出性心包炎外）长期益处甚微。
