Beneficial effect of intravenous dexamethasone in children with mild to moderately severe acute chest syndrome complicating sickle cell disease
Beneficial effect of intravenous dexamethasone in children with mild to moderately severe acute chest syndrome complicating sickle cell disease
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DOI：
10.1182/blood.v92.9.3082.421k15_3082_3089
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发表时间：
1998-11-01
期刊：
影响因子：
20.3
通讯作者：
Buchanan, GR
中科院分区：
文献类型：
--
作者：
Bernini, JC;Rogers, ZR;Buchanan, GR
镰状细胞病（SCD）患者的急性胸部综合征（ACS）历来采用氧气、抗生素和输血治疗，最近大剂量皮质类固醇治疗显示可缩短SCD和血管闭塞危象儿童的住院时间。因此，我们选择评估糖皮质激素在ACS中的使用，我们进行了一项随机、双盲、安慰剂对照试验，以评估静脉内地塞米松（0.3 mg/kg，每12小时一次，4次给药）在因轻度至中重度ACS住院的SCD儿童中的疗效和毒性。38名儿童（中位年龄6.7岁）发生了43次可评估的ACS发作。22例患者接受地塞米松治疗，21例患者接受安慰剂治疗。两组之间的人口统计学、临床或实验室特征无统计学显著差异。地塞米松治疗组的平均住院时间较短（47小时vs 80小时; P = .005）。地塞米松治疗预防了临床恶化，减少了输血的需要（分别为P <0.001和= 0.013）。地塞米松治疗的患者的平均吸氧和镇痛治疗时间、阿片类药物剂量次数和发热持续时间也显著缩短。出院后72小时内再次入院的7例患者中（6例使用地塞米松; P = 0.095），只有1例发生呼吸系统并发症（P = 1.00）。未观察到明显与地塞米松相关的副作用。在逐步多元线性回归分析中，性别和既往ACS发作是预测地塞米松治疗反应的唯一变量，以住院时间为衡量标准。静脉注射地塞米松对因轻度至中重度急性胸部综合征住院的SCD儿童有有益作用，需要进一步研究这种治疗方式。(C)1998年，美国血液学会。
Acute chest syndrome (ACS) in patients with sickle cell disease (SCD) has historically been managed with oxygen, antibiotics, and blood transfusions, Recently high-dose corticosteroid therapy was shown to reduce the duration of hospitalization in children with SCD and vaso-occlusive crisis. Therefore, we chose to assess the use of glucocorticolds in ACS, We conducted a randomized, double-blind placebo-controlled trial to evaluate the efficacy and toxicity of intravenous dexamethasone (0.3 mg/kg every 12 hours x 4 doses) in children with SCD hospitalized with mild to moderately severe ACS. Forty-three evaluable episodes of ACS occurred in 38 children (median age, 6.7 years). Twenty-two patients received dexamethasone and 21 patients received placebo. There were no statistically significant differences in demographic, clinical, or laboratory characteristics between the two groups. Mean hospital stay was shorter in the dexamethasone-treated group (47 hours v 80 hours; P = .005). Dexamethasone therapy prevented clinical deterioration and reduced the need for blood transfusions (P < .001 and = .013, respectively). Mean duration of oxygen and analgesic therapy, number of opioid doses, and the duration of fever was also significantly reduced in the dexamethasone-treated patients. Of seven patients readmitted within 72 hours after discharge (six after dexamethasone; P = .095), only one had respiratory complications (P = 1.00). No side effects clearly related to dexamethasone were observed. In a stepwise multiple linear regression analysis, gender and previous episodes of ACS were the only variables that appeared to predict response to dexamethasone, as measured by lengh of hospital stay, Intravenous dexamethasone has a beneficial effect in children with SCD hospitalized with mild to moderately severe acute chest syndrome, Further study of this therapeutic modality is indicated. (C) 1998 by The American Society of Hematology.