Effect of corticosteroids on the clinical course of community-acquired pneumonia: a randomized controlled trial.
Effect of corticosteroids on the clinical course of community-acquired pneumonia: a randomized controlled trial.
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DOI：
10.1186/cc10103
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发表时间：
2011-03-15
期刊：
影响因子：
--
通讯作者：
Manresa F
中科院分区：
文献类型：
--
作者：
Fernández-Serrano S;Dorca J;Garcia-Vidal C;Fernández-Sabé N;Carratalà J;Fernández-Agüera A;Corominas M;Padrones S;Gudiol F;Manresa F
皮质类固醇作为需要住院的严重社区获得性肺炎(CAP)患者的辅助治疗的益处仍不清楚。本研究旨在评估糖皮质激素治疗对CAP患者预后的影响。这是一项前瞻性、双盲、随机研究。所有患者都接受了头孢曲松加左氧氟沙星和甲基强的松龙(MPDN)的治疗，作为最初的随机和盲目给药，然后是逐渐减少的方案，或安慰剂。在纳入研究的56名患者中，28名(50%)接受了同时使用皮质类固醇的治疗。包括在MPDN组的患者在7天内表现出更有利的PO2/FiO2比率的演变和更快的退烧，以及更大的放射学改善。在这组患者中，发病率的解决时间也显著缩短。6例患者符合机械通气(MV)标准：安慰剂组5例(22.7%)，MPDN组1例(4.3%)。安慰剂组的MV持续时间为13天(四分位数范围为7至26天)，MPDN组的唯一病例为3天。差异无统计学意义。治疗24 h后，MPDN患者的IL-6和C-反应蛋白(CRP)下降速度明显加快。不同组之间的死亡率没有差异。MPDN治疗与抗生素相结合，可以改善呼吸衰竭，加快需要住院的严重CAP的临床缓解时间。国际标准随机对照试验登记，ISRCTN22426306。
The benefit of corticosteroids as adjunctive treatment in patients with severe community-acquired pneumonia (CAP) requiring hospital admission remains unclear. This study aimed to evaluate the impact of corticosteroid treatment on outcomes in patients with CAP. This was a prospective, double-blind and randomized study. All patients received treatment with ceftriaxone plus levofloxacin and methyl-prednisolone (MPDN) administered randomly and blindly as an initial bolus, followed by a tapering regimen, or placebo. Of the 56 patients included in the study, 28 (50%) were treated with concomitant corticosteroids. Patients included in the MPDN group show a more favourable evolution of the pO2/FiO2 ratio and faster decrease of fever, as well as greater radiological improvement at seven days. The time to resolution of morbidity was also significantly shorter in this group. Six patients met the criteria for mechanical ventilation (MV): five in the placebo group (22.7%) and one in the MPDN group (4.3%). The duration of MV was 13 days (interquartile range 7 to 26 days) for the placebo group and three days for the only case in the MPDN group. The differences did not reach statistical significance. Interleukin (IL)-6 and C-reactive protein (CRP) showed a significantly quicker decrease after 24 h of treatment among patients treated with MPDN. No differences in mortality were found among groups. MPDN treatment, in combination with antibiotics, improves respiratory failure and accelerates the timing of clinical resolution of severe CAP needing hospital admission. International Standard Randomized Controlled Trials Register, ISRCTN22426306.
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DOI：
10.1016/s0140-6736(03)15021-0
发表时间：
2003-12-13
期刊：
Lancet (London, England)
影响因子：
--
作者：
File TM
通讯作者：
File TM
DOI：
10.1164/rccm.200905-0808oc
发表时间：
2010-05-01
影响因子：
24.7
作者：
Snijders, Dominic;Daniels, Johannes M. A.;Boersma, Wim G.
通讯作者：
Boersma, Wim G.
影响因子：
39.2
作者：
AUSTRIAN, R;GOLD, J
通讯作者：
GOLD, J
影响因子：
9.6
作者：
MARIK, P;KRAUS, P;JOHNSON, DW
通讯作者：
JOHNSON, DW
影响因子：
11.8
作者：
Rosón, B;Carratalà, J;Gudiol, F
通讯作者：
Gudiol, F