糖皮质激素治疗成人社区获得性肺炎适应证的荟萃分析  

The indications for glucocorticoids in treating community-acquired pneumonia in adults： a meta-analysis

作　　者：田欣伦[1] 江梅[2] 孙雪峰[1] 詹永忠[3] 王世波 康闪闪[5] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院呼吸内科,100730 [2]广州医科大学附属第一医院呼吸病研究所呼吸及危重症医学科 [3]南方医科大学南方医院呼吸及危重症医学科 [4]山东省潍坊市第二人民医院呼吸及危重症医学科 [5]广州医科大学附属第三医院呼吸及危重症医学科

出　　处：《中华结核和呼吸杂志》2016年第4期280-285,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的 采用荟萃分析方法研究糖皮质激素（GCS）治疗社区获得性肺炎（CAP）的适应证.方法 采用荟萃分析方法,以“steroids,glucocorticoids,corticosteroids,hydrocortisone,prednisone,cortisol,methylprednisolone,dexamethasone”和“community-acquired pneumonia”为英文检索词,检索PubMed、EMbase、MEDLINE、Cochrane数据库.以“糖皮质激素、类固醇、氢化可的松、地塞米松、社区获得性肺炎”为中文检索词,检索中国知网和万方数据库.检索时间自建库至2015年3月31日.纳入了11篇高质量的随机对照研究,分析了GCS在CAP治疗中的价值.结果 检索840篇文献,最终纳入文献11篇,共纳入1 942例成人CAP患者,因并非所有文献都有患者的年龄和性别资料,故无法进行统计分析.荟萃分析结果显示,GCS能略降低全部CAP患者的病死率（OR=0.68,95％ CI为0.46 ～0.99,P=0.04）,这种获益主要来自于病情严重的CAP患者（OR =0.35,95％ CI为0.17 ～0.75,P=0.007）.GCS可明显增加CAP患者需要用胰岛素干预的高血糖的发生率（OR=1.99,95％ CI为1.50～2.65,P＜0.000 01）.结论 全身糖皮质激素仅应谨慎用于重症CAP患者.Objective Community acquired pneumonia （CAP） is a common pulmonary infectious disease.Glucocorticoids （GCS） as one of the most powerful anti-inflammation drugs,are still the most controversial adjuvant therapy in treating CAP.Which sub-groups of CAP patients would benefit from GCS is a debating topic.Our aim of this study is to find the indications for GCS in treating adult CAP patients by using meta-analysis.Method ＆quot; Steroids,glucocorticoids,corticosteroids,hydrocortisone,prednisone,cortisol,methylprednisolone,dexamethasone＆quot; and ＆quot;community-acquired pneumonia＆quot; were used as key words both in Chinese and English to search all published literature in Pubmed,EMBASE MEDLINE,Cochrane,CNKI and Wanfang Database until March 2015.Results All 840 articles were reviewed,and 11 high quality randomized clinical trials involving 1942 adult CAP patients were included in this meta-analysis.Using GCS did not significantly reduce mortality in all CAP patients （OR =0.68,95% CI 0.46-0.99,P =0.04）.But in the subgroup analysis,patients with severe CAP benefited from GCS treatment （OR =0.35,95% CI 0.17-0.75,P =0.007）.GCS also increased the risk of hyperglycemia （OR =1.99,95% CI 1.50-2.65,P 〈 0.000 01）.Conclusion Results from this meta-analysis suggested that GCS should only be rigorously used in severe CAP patients.

关 键 词：肺炎 糖皮质激素 META分析 

分 类 号：R563.1[医药卫生—呼吸系统]