Corticosteroids in the treatment of community-acquired pneumonia in adults: a meta-analysis.
Corticosteroids in the treatment of community-acquired pneumonia in adults: a meta-analysis.
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皮质类固醇治疗成人社区获得性肺炎的荟萃分析
DOI：
10.1371/journal.pone.0047926
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Xiu Q
中科院分区：
文献类型：
--
作者：
Nie W;Zhang Y;Cheng J;Xiu Q
皮质类固醇在社区获得性肺炎（CAP）中的益处仍然存在争议。我们做了一个荟萃分析，包括所有的随机对照试验（RCT），使用糖皮质激素作为连续治疗，以检查糖皮质激素在治疗成人CAP的好处和风险。检索数据库，包括Pubmed、EMBASE、科克伦对照试验注册库和Google Scholar，以查找相关试验。纳入了成人CAP患者皮质类固醇治疗的随机和半随机试验。在该荟萃分析中评估了对主要结局（死亡率）和次要结局（不良事件）的影响。纳入了9项试验，涉及1001例患者。使用皮质类固醇并没有显著降低死亡率（Peto比值比[OR] 0.62，95%置信区间[CI] 0.37-1.04; P = 0.07）。 在按严重程度进行的亚组分析中，在重度CAP患者中发现了生存获益（Peto OR 0.26，95% CI 0.11-0.64; P = 0.003）。 在按皮质类固醇治疗持续时间进行的亚组分析中，发现长期皮质类固醇治疗患者的死亡率显著降低（Peto OR 0. 51，95% CI 0. 26 - 0. 97; P = 0. 04; I2 = 37%）。 皮质类固醇增加了高血糖的风险（Peto OR 2.64，95% CI 1.68-4.15; P<0.0001），但没有增加胃十二指肠出血（Peto OR 1.67，95% CI 0.41-6.80; P = 0.47）和双重感染（Peto OR 1.36，95% CI 0.65-2.84; P = 0.41）的风险。 这项荟萃分析的结果并没有表明皮质类固醇治疗对CAP患者有益。然而，皮质类固醇的使用与严重CAP死亡率的改善相关。此外，延长皮质类固醇治疗对死亡率有有益影响。这些结果应该通过未来充分把握度的随机试验来证实。
The benefit of corticosteroids in community-acquired pneumonia (CAP) remains controversial. We did a meta-analysis to include all the randomized controlled trials (RCTs) which used corticosteroids as adjunctive therapy, to examine the benefits and risks of corticosteroids in the treatment of CAP in adults. Databases including Pubmed, EMBASE, the Cochrane controlled trials register, and Google Scholar were searched to find relevant trials. Randomized and quasi-randomized trials of corticosteroids treatment in adult patients with CAP were included. Effects on primary outcome (mortality) and secondary outcomes (adverse events) were accessed in this meta-analysis. Nine trials involving 1001 patients were included. Use of corticosteroids did not significantly reduce mortality (Peto odds ratio [OR] 0.62, 95% confidence interval [CI] 0.37–1.04; P = 0.07). In the subgroup analysis by the severity, a survival benefit was found among severe CAP patients (Peto OR 0.26, 95% CI 0.11–0.64; P = 0.003). In subgroup analysis by duration of corticosteroids treatment, significant reduced mortality was found among patients with prolonged corticosteroids treatment (Peto OR 0.51, 95% CI 0.26–0.97; P = 0.04; I 2 = 37%). Corticosteroids increased the risk of hyperglycemia (Peto OR 2.64, 95% CI 1.68–4.15; P<0.0001), but without increasing the risk of gastroduodenal bleeding (Peto OR 1.67, 95% CI 0.41–6.80; P = 0.47) and superinfection (Peto OR 1.36, 95% CI 0.65–2.84; P = 0.41). Results from this meta-analysis did not suggest a benefit for corticosteroids treatment in patients with CAP. However, the use of corticosteroids was associated with improved mortality in severe CAP. In addition, prolonged corticosteroids therapy suggested a beneficial effect on mortality. These results should be confirmed by future adequately powered randomized trials.