Pareja J G, Garland R, Koziel H
Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA.
Chest. 1998 May;113(5):1215-24. doi: 10.1378/chest.113.5.1215.
To examine the use of adjunctive corticosteroids in cases of severe Pneumocystis carinii pneumonia (PCP) in non-HIV-infected adult patients.
Retrospective review of medical records.
Tertiary care urban teaching hospital.
Review identified 31 consecutive histologically confirmed primary cases of adult non-HIV-related PCP. Complete records were available for 30 patients, including 20 male and 10 female patients with a mean age of 58.3+/-15 years (+/-SD). Underlying conditions included organ transplantation (n=13), long-term immunosuppressive therapy (n=9), and chemotherapy for malignancy (n=8). All patients had documented PO2 <65 mm Hg or arterial oxygen saturation <90% on room air.
Following the identification of P carinii, in addition to trimethoprim-sulfamethoxazole or pentamidine therapy, 16 patients received increased steroids (> or =60 mg prednisone daily equivalent; increased high-dose steroid group), whereas 14 patients were maintained on a regimen of low doses (< or =30 mg prednisone equivalent daily) or had steroid therapy tapered (low-dose steroid group).
The increased high-dose steroid group demonstrated a shorter required duration for mechanical ventilation (6.3+/-6 days vs 18.0+/-21 days; p=0.047), a shorter duration of ICU admission (8.5+/-7 days vs 15.8+/-8 days; p=0.025), and a shorter duration of supplemental oxygen use (10.0+/-4 vs 32.2+/-33; p=0.05). The hospital duration to discharge for the nine survivors in each group favored the use of corticosteroids (15.4+/-5 days vs 36.3+/-33 days; p=0.077). Similar rates were observed for intubation (75% vs 57%; p=0.442) and in-hospital mortality (44% vs 36%; p=0.722).
These preliminary data suggest that high-dose adjunctive corticosteroids may accelerate recovery in cases of severe adult non-HIV PCP.
探讨在非HIV感染的成年患者严重卡氏肺孢子虫肺炎（PCP）病例中辅助使用皮质类固醇的情况。
对病历进行回顾性研究。
城市三级护理教学医院。
回顾确定了31例连续的经组织学证实的成年非HIV相关PCP原发性病例。30例患者有完整记录，包括20例男性和10例女性，平均年龄58.3±15岁（±标准差）。基础疾病包括器官移植（n = 13）、长期免疫抑制治疗（n = 9）和恶性肿瘤化疗（n = 8）。所有患者在室内空气中记录的PO2<65 mmHg或动脉血氧饱和度<90%。
确诊卡氏肺孢子虫后，除甲氧苄啶-磺胺甲恶唑或喷他脒治疗外，16例患者接受增加剂量的类固醇治疗（≥60 mg泼尼松等效剂量/天；增加高剂量类固醇组），而14例患者维持低剂量治疗方案（≤30 mg泼尼松等效剂量/天）或逐渐减少类固醇治疗（低剂量类固醇组）。
增加高剂量类固醇组的机械通气所需时间较短（6.3±6天对18.0±21天；p = 0.047），入住重症监护病房的时间较短（8.5±7天对15.8±8天；p = 0.025），补充氧气使用时间较短（10.0±4天对32.2±33天；p = 0.05）。每组9名幸存者的出院住院时间有利于使用皮质类固醇（15.4±5天对36.3±33天；p = 0.077）。插管率（75%对57%；p = 0.442）和住院死亡率（44%对36%；p = 0.722）相似。
这些初步数据表明，高剂量辅助皮质类固醇可能会加速严重成年非HIV PCP病例的康复。
