Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review.
Systemic glucocorticoid therapy and adrenal insufficiency in adults: A systematic review.
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DOI：
10.1016/j.semarthrit.2016.03.001
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发表时间：
2016-08
影响因子：
5
通讯作者：
Dixon WG
中科院分区：
文献类型：
--
作者：
Joseph RM;Hunter AL;Ray DW;Dixon WG
本系统性文献综述的目的是总结关于糖皮质激素诱导的肾上腺皮质功能不全（AI）的患病率、恢复时间以及糖皮质激素剂量和持续时间的影响的现有知识。合格的研究是原始研究文章，其中包括糖皮质激素适应症的成人患者，并在暴露于全身性糖皮质激素后测量肾上腺功能。在Web of Science和MEDLINE中进行检索，并从参考文献列表中识别更多文章。筛选一式两份进行。在合格的研究中提取每组糖皮质激素暴露患者的数据。报告的AI患者比例总结为中位数和四分位数间距。然后根据每日剂量、累积剂量、暴露持续时间和自末次糖皮质激素使用后的时间对结果进行分层。考虑了研究内和研究间的偏倚风险：对于随机对照试验，使用科克伦协作组开发的工具评估偏倚风险。总体而言，在筛选的673项研究中确定了73项合格研究。AI患者百分比范围为0%-100%，中位数（IQR）= 37.4%（13-63%）。研究是小中位数（IQR）组大小16（9-38）-和异质性的方法。在停用糖皮质激素3年后复查的患者中，15%的患者AI持续存在。分层后结果仍广泛分布。当泼尼松龙等效剂量<5 mg/天、暴露时间<4周、累积剂量<0.5 g和逐渐停药后，AI得到证实。研究的异质性和结果的可变性使得很难根据现有文献自信地回答研究问题。有证据表明，低剂量和短时间的糖皮质激素后AI。因此，临床医生应警惕肾上腺皮质功能不全在所有程度的糖皮质激素暴露。
The aim of this systematic literature review was to summarize the current knowledge regarding the prevalence of, time to recovery from, and influence of glucocorticoid dose and duration on glucocorticoid-induced adrenal insufficiency (AI). Eligible studies were original research articles, which included adult patients with an indication for glucocorticoids and measured adrenal function following exposure to systemic glucocorticoids. Searches were performed in Web of Science and MEDLINE, with further articles identified from reference lists. Screening was performed in duplicate. Data were extracted for each group of glucocorticoid-exposed patients within eligible studies. The reported proportion of patients with AI was summarized as median and inter-quartile range. Results were then stratified by daily dose, cumulative dose, duration of exposure and time since last glucocorticoid use. The risk of bias within and across studies was considered: for randomised controlled trials risk of bias was assessed using the tool developed by the Cochrane Collaboration. Overall, 73 eligible studies were identified out of 673 screened. The percentage of patients with AI ranged from 0% to 100% with a median (IQR) = 37.4% (13–63%). Studies were small—median (IQR) group size 16 (9–38)—and heterogeneous in methodology. AI persisted in 15% of patients retested 3 years after glucocorticoid withdrawal. Results remained widely distributed following stratification. AI was demonstrated at <5 mg prednisolone equivalent dose/day, <4 weeks of exposure, cumulative dose <0.5 g, and following tapered withdrawal. The heterogeneity of studies and variability in results make it difficult to answer the research questions with confidence based on the current literature. There is evidence of AI following low doses and short durations of glucocorticoids. Hence, clinicians should be vigilant for adrenal insufficiency at all degrees of glucocorticoid exposure.