Mer M, Richards G A
Department of Medicine, University of the Witwatersrand Medical School, Johannesburg, South Africa.
Chest. 1998 Aug;114(2):426-31. doi: 10.1378/chest.114.2.426.
Varicella pneumonia that results in respiratory failure or progresses to the institution of mechanical ventilation carries a significant morbidity and mortality despite intensive respiratory support and antiviral therapy. There has been no reported study of the role of corticosteroids in life-threatening varicella pneumonia.
This was an uncontrolled retrospective and prospective study of all adult patients with a diagnosis of varicella pneumonia who were admitted to the ICUs of the Johannesburg group of academic hospitals in South Africa between 1980 and 1996. Patient demographics, clinical and laboratory features, necessity for mechanical ventilation, and complications were reviewed. The outcome and therapy of varicella pneumonia was evaluated with particular reference to the use of corticosteroids. Patients with comorbid disease and those already taking immunosuppressive agents were excluded. Key endpoints included length of ICU and hospital stay and mortality.
Fifteen adult patients were evaluated, six of whom received corticosteroids in addition to antiviral and supportive therapy. These six patients demonstrated a clinically significant therapeutic response. They had significantly shorter hospital (median difference, 10 days; p<0.006) and ICU (median difference, 8 days; p=0.008) stays and there was no mortality, despite the fact that they were admitted to the ICU with significantly lower median ratios between PaO2 and fraction of inspired oxygen than those patients (n=9) who did not receive corticosteroid therapy (86.5 vs 129.5; p=0.045).
When used in addition to appropriate supportive care and early institution of antiviral therapy, corticosteroids appear to be of value in the treatment of previously well patients with life-threatening varicella pneumonia. The observations presented in this study are important and should form the basis for a randomized controlled trial, as no other relevant studies or guidelines are available.
尽管进行了强化呼吸支持和抗病毒治疗，但导致呼吸衰竭或进展为需要机械通气的水痘肺炎仍具有较高的发病率和死亡率。目前尚无关于皮质类固醇在危及生命的水痘肺炎中作用的报道研究。
这是一项对1980年至1996年间入住南非约翰内斯堡学术医院集团重症监护病房的所有诊断为水痘肺炎的成年患者进行的非对照回顾性和前瞻性研究。回顾了患者的人口统计学、临床和实验室特征、机械通气的必要性及并发症。特别参照皮质类固醇的使用情况评估了水痘肺炎的结局和治疗方法。排除患有合并症和已在服用免疫抑制剂的患者。主要终点包括重症监护病房和住院时间以及死亡率。
对15名成年患者进行了评估，其中6名患者除接受抗病毒和支持治疗外还接受了皮质类固醇治疗。这6名患者表现出临床上显著的治疗反应。他们的住院时间（中位数差异为10天；p<0.006）和重症监护病房住院时间（中位数差异为8天；p=0.008）明显更短，且无死亡病例，尽管他们入住重症监护病房时的动脉血氧分压与吸入氧分数的中位数比值明显低于未接受皮质类固醇治疗的患者（9名）（86.5对129.5；p=0.045）。
在适当的支持治疗和早期抗病毒治疗基础上使用时，皮质类固醇似乎对治疗既往健康但患有危及生命的水痘肺炎的患者有价值。本研究中的观察结果很重要，应作为随机对照试验的基础，因为目前尚无其他相关研究或指南。
