High-dose pulse versus nonpulse corticosteroid regimens in severe acute respiratory syndrome
High-dose pulse versus nonpulse corticosteroid regimens in severe acute respiratory syndrome
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DOI：
10.1164/rccm.200306-766oc
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发表时间：
2003-12-15
影响因子：
24.7
通讯作者：
Tsang, KW
中科院分区：
文献类型：
--
作者：
Ho, JC;Ooi, GC;Tsang, KW
非典型肺炎，后来被称为严重急性呼吸综合征（SARS），治疗是有争议的，皮质类固醇治疗的疗效是未知的。我们已经评估了72例可能的SARS患者（中位年龄37岁，30 M），谁收到利巴韦林和不同的类固醇方案在两个地区医院的临床和影像学结果。胸片根据受累肺野的百分比进行评分。17名患者最初接受脉冲类固醇（PS）（甲基强的松龙大于或等于500 mg/天），55名患者最初接受非脉冲类固醇（MENS）（甲基强的松龙< 500 mg/天）治疗。累积类固醇剂量; 21天后，两组的重症监护室入院率、机械通气率和死亡率以及血液学和生化参数相似。然而，PS组患者的需氧量较低，影像学结局较好，需要补救PS治疗的可能性较低。两组在溶血性贫血、严重继发感染或呕血方面无显著差异，但PS组患者的高血糖症较少。与低剂量方案相比，最初使用甲基强的松龙脉冲治疗似乎是一种更有效且同样安全的类固醇方案，应被视为治疗SARS的首选类固醇方案，有待未来随机对照试验的数据。
The treatment of atypical pneumonia, subsequently termed severe acute respiratory syndrome (SARS), is controversial, and the efficacy of corticosteroid therapy is unknown. We have evaluated the clinical and radiographic outcomes of 72 patients with probable SARS (median age 37 years, 30 M), who received ribavirin and different steroid regimens in two regional hospitals. Chest radiographs were scored according to the percentage of lung field involved. Seventeen patients initially received pulse steroid (PS) (methylprednisolone greater than or equal to 500 mg/day) and 55 patients initially received nonpulse steroid (NPS) (methylprednisolone < 500 mg/day) therapy. The cumulative steroid dosage; intensive care unit admission, mechanical ventilation, and mortality rates; and hematologic and biochemical parameters were similar in both groups after 21 days. However, patients in the PS group had less oxygen requirement, better radiographic outcome, and less likelihood of requiring rescue PS therapy than their counterparts. There was no significant difference between the two groups in hemolytic anemia, severe secondary infections, or hematemesis, but patients in the PS group had less hyperglycaemia. Initial use of pulse methylprednisolone therapy appears to be a more efficacious and an equally safe steroid regimen when compared with regimens with lower dosage and should be considered as the preferred steroid regimen in the treatment of SARS, pending data from future randomized controlled trials.