HYDROCORTISONE AND TUMOR-NECROSIS-FACTOR IN SEVERE COMMUNITY-ACQUIRED PNEUMONIA - A RANDOMIZED CONTROLLED-STUDY
HYDROCORTISONE AND TUMOR-NECROSIS-FACTOR IN SEVERE COMMUNITY-ACQUIRED PNEUMONIA - A RANDOMIZED CONTROLLED-STUDY
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DOI：
10.1378/chest.104.2.389
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发表时间：
1993-08-01
期刊：
影响因子：
9.6
通讯作者：
JOHNSON, DW
中科院分区：
文献类型：
--
作者：
MARIK, P;KRAUS, P;JOHNSON, DW
背景：社区获得性肺炎是第三世界国家的一个主要原因。抗菌治疗可能对重症肺炎患者的自然病程影响不大。我们假设肺内产生的肿瘤坏死因子-α (TNF-α) 可能是重症肺炎患者开始抗生素治疗后常见的进行性肺损伤和休克的原因。目的：探讨单次推注氢化可的松对社区获得性重症肺炎患者临床病程和血清 TNF-α 水平的影响。设计：随机安慰剂对照研究。地点：三级护理教学的多学科 ICU医院。 患者和方法：对符合三种或三种以上英国胸科学会重症肺炎标准的患者进行了研究。在开始抗生素治疗前 30 分钟，患者被随机分配接受单剂量氢化可的松 (10 mg/kg) 或安慰剂。根据临床指示，患者接受头孢噻肟和其他抗生素治疗。入院时抽取血液检测 TNF-α，并在开始抗生素治疗后 2、6 和 12 b 重复进行。结果：研究了 30 名患者：16 名接受安慰剂，14 名接受氢化可的松。接受安慰剂的患者往往比接受氢化可的松的患者病情更严重。安慰剂组的基线 TNF-α 值为 989 +/- 374 pg/ml，氢化可的松组的基线 TNF-α 值为 827 +/- 394 pg/ml。两组患者的 TNF-α 水平均未随时间发生显着变化。 TNF-α 水平与 APACHE II 评分、肺损伤评分或结果之间没有相关性。预测结果的唯一变量是 APACHE II 评分。结论：杀菌抗生素不会增加重症肺炎患者的血清 TNF-α 水平。抗生素治疗前给予氢化可的松对严重社区获得性肺炎患者的血清 TNF-α 水平或临床病程没有影响。
Background: Community-acquired pneumonia is a major cause of death in third world countries. Antimicrobial therapy may have little impact on the natural history of patients with severe pneumonia. We hypothesized that the intrapulmonary production of tumor necrosis factor-alpha (TNF-alpha) may be responsible for the progressive lung injury and shock commonly seen in patients with severe pneumonia after commencing antibiotic therapy.Aim: To investigate the effects of a single bolus of hydrocortisone on the clinical course and serum TNF-alpha levels of patients with severe community-acquired pneumonia.Design: Randomized placebo-controlled study.Setting: Multidisciplinary ICU of a tertiary care teaching hospital.Patients and methods: Patients with three or more British Thoracic Society criteria of severe pneumonia were studied. Patients were randomized to receive either a single dose of hydrocortisone (10 mg/kg) or placebo 30 min prior to commencing antibiotic therapy. Patients were treated with cefotaxime and other antibiotics as clinically indicated. Blood for TNF-alpha was taken at the time of hospital admission and repeated 2, 6, and 12 b after starting antibiotic therapy.Results: Thirty patients were studied: 16 received placebo and 14 received hydrocortisone. The patients who received placebo tended to be sicker than the patients who received hydrocortisone. The baseline TNF-alpha value was 989 +/- 374 pg/ml in the placebo group and 827 +/- 394 pg/ml in the hydrocortisone group. In both groups of patients, the TNF-alpha levels did not change significantly with time. There was no correlation between the TNF-alpha levels and the APACHE II score, lung injury score, or outcome. The only variable that predicted outcome was the APACHE II score.Conclusion: Bactericidal antibiotics do not increase serum TNF-alpha levels in patients with severe pneumonia. Hydrocortisone given prior to antibiotic treatment had no effect on the serum TNF-alpha levels or the clinical course of patients with severe community-acquired pneumonia.