系统性糖皮质激素对重症社区获得性肺炎患者预后的影响:一项多中心的回顾性研究  

Impact of systemic corticosteroids on the clinical outcomes in patients with severe community-acquired pneumonia: a multi-center retrospective study

作　　者：陈亮[1] 韩秀迪[2] 李艳丽 张春晓 邢西迁 Chen Liang;Han Xiudi;Li Yanli;Zhang Chunxiao;Xing Xiqian(Department of Infectious Disease,Beijing Jishuitan Hospital,Beijing 100096,China;Department of Respiratory and Critical Care Medicine,Qingdao Municipal Hospital,Qingdao 266011,Shandong,China;Department of Infectious Diseases and Clinical Microbiology,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100043,China;Department of Respiratory Medicine,Beijing Huimin Hospital,Beijing 100053,China;Department of Respiratory and Critical Care Medicine,the Second People's Hospital of Yunnan Province,Kunming 650021,Yunnan,China)

机构地区：[1]北京积水潭医院感染疾病科,100096 [2]青岛市市立医院呼吸与危重症医学科,山东青岛266011 [3]首都医科大学附属北京朝阳医院临床微生物与感染科,100043 [4]北京市回民医院呼吸科,100053 [5]云南省第二人民医院呼吸与危重症医学科,云南昆明650021

出　　处：《中华危重病急救医学》2019年第7期815-820,共6页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81760015).

摘　　要：目的探讨短期低剂量系统性糖皮质激素治疗对重症社区获得性肺炎(SCAP)患者临床结局的影响.方法采用多中心回顾性研究方法,收集2013年1月1日至2015年12月31日在北京、山东和云南三省5家教学医院收治的SCAP住院患者病例资料.根据是否接受糖皮质激素治疗,将患者分为激素组和非激素组.收集入选患者的性别、年龄、基础疾病,入院当天的血常规、生化检查和影像学资料(多次检查者取最异常值),支持治疗,并发症(需要胰岛素治疗的高血糖和消化道出血)以及临床结局〔早期(0~3 d)治疗失败、晚期(4~14 d)治疗失败、30 d病死率,治疗失败定义为需要无创或有创机械通气、需要使用血管活性药物或死亡〕.采用单因素和多因素Logistic回归分析评估短期低剂量系统性糖皮质激素对SCAP患者临床结局的影响.结果对3 561例免疫功能正常的成人或青年社区获得性肺炎(CAP)患者进行筛选,最终共有132例SCAP患者纳入分析,其中激素组24例,非激素组108例.激素组患者甲泼尼龙使用剂量(0.6±0.1)mg·kg-1·d-1,使用时间(4.0±1.7)d.与非激素组比较,激素组患者年龄较小〔岁:70.5(59.0,75.0)比80.0(76.0,85.0)〕,男性〔41.7%(10/24)比72.2%(78/108)〕及基础疾病为心血管病〔16.7%(4/24)比42.6%(46/108)〕、脑血管病〔0%(0/24)比40.7%(44/108)〕和意识改变比例〔16.7%(4/24)比40.7%(44/108)〕较低,基础疾病为慢性阻塞性肺病〔COPD, 41.7%(10/24)比13.0%(14/108)〕、哮喘〔25.0%(6/24)比1.9%(2/108)〕、慢性肝病〔8.3%(2/24)比0%(0/108)〕和呼吸频率≥30次/min的比例〔33.3%(8/24)比9.3%(10/108)〕较高,差异均有统计学意义(均P<0.05);且激素组患者应用符合指南的经验性抗感染治疗、早期需要无创机械通气、晚期出现消化道出血、早期和晚期出现需要胰岛素治疗的高血糖比例均明显高于非激素组〔50.0%(12/24)比21.3%(23/108),33.3%(8/24)比7.4%(8/108),20.8%(5/24)比4.6%(5/108)Objective To assess the impact of short-term, low-dose systemic glucorticosteroids treatment on the clinical outcomes in patients with severe community-acquired pneumonia (SCAP). Methods A multi-center retrospective study was conducted. Data of patients hospitalized with SCAP in five teaching hospitals from Beijing, Shandong and Yunnan Provinces from January 1st, 2013 to December 31st, 2015 were reviewed. Patients were divided into steroids group and non-steroids group according to whether treated with glucorticosteroids during the disease course or not. Data of patients were reviewed, including gender, age, underlying disease, blood routine, biochemical examination and radiology findings (the worst value was recorded if there were more than one value), supportive treatment, complications (hyperglycemia needing insulin treatment and gastrointestinal bleeding) and clinical outcomes [early (0-3 days) treatment failure, late (4-14 days) treatment failure and 30-day mortality, treatment failure was defined as one of the followings: needing noninvasive or invasive ventilation, needing vasopressor use or death]. Univariate and multivariate Logistic regression was performed to evaluate the impact of short-term, low-dose systemic glucorticosteroids on the clinical outcomes in SCAP patients. Results Overall, 3?561 immunocompetent adult and adolescent patients with community-acquired pneumonia (CAP) were screened, 132 SCAP patients were entered into final analysis, including 24 patients in steroids group and 108 patients in non-steroids group. The patients in steroids group were prescribed with methylprednisolone (0.6±0.1) mg·kg-1·d-1 for (4.0±1.7) days. Compared with patients in non-steroids group, patients in steroids group showed younger age [years old: 70.5 (59.0, 75.0) vs. 80.0 (76.0, 85.0)], less frequency of male [41.7%(10/24) vs. 72.2%(78/108)], less comorbidities with cardiovascular [16.7%(4/24) vs. 42.6%(46/108)] and cerebrovascular disease [0%(0/24) vs. 40.7%(44/108)], less confusion [16.7%(4/24) vs. 40.7%(4

关 键 词：系统性糖皮质激素 重症社区获得性肺炎 预后 

分 类 号：R563.1[医药卫生—呼吸系统]