口服类固醇并非对所有急性下呼吸道感染都有益处

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感控热点丨口服类固醇并非对所有急性下呼吸道感染都有益处

原创 2017-09-26 SIFIC热点 SIFIC感染官微

翻译丨陈燕卿

审核丨陈志锦

团队丨SIFIC热点

一项研究发现，与安慰剂相比，口服类固醇不会降低急性下呼吸道感染的非哮喘成人的症状严重程度或持续时间。

研究人员写道：“这项试验表明，口服皮质类固醇不适宜应用于无需立即使用抗生素治疗且未并发哮喘或慢性阻塞性肺疾病的成年急性下呼吸道感染患者。

来自英国布里斯托大学的FRCGP的Alastair G.Hay和他的同事在JAMA8月刊发表了他们的研究结果。

2013年7月至2014年10月期间，研究人员在54个英国家庭开展了随机对照试验。其中包括401名成年人，平均年龄47岁，女性63％，吸烟者17％。 参与者患有急性咳嗽和至少一种下呼吸道症状，不需要立即进行抗生素药物治疗。 他们在过去5年没有慢性阻塞性肺疾病或哮喘的病史。

研究人员随机指定参与者每天接受口服强的松龙片（n=199）40mg/天或匹配的安慰剂（n=202），一共5天。参与者测量他们的呼气峰峰值每天两次，持续28天或直到症状消失。 患者报告咳嗽症状改变情况持续超过28天。分析年龄、性别、流感疫苗、吸烟以及基线因素的可能差异来调整结果。同样地，两组在急性下呼吸道感染、抗生素使用和非严重不良事件的其他症状方面没有显着差异。

研究结果显示，两组患者的中重度咳嗽持续时间中位数相近，均约为5天（完全调整的风险比1.09;95％置信区间0.87-1.37; P=0.44）。调整潜在混杂因素后，泼尼松组的平均症状严重程度评分为1.99，安慰剂组为2.16（完全调整的风险比-0.17;95％置信区间-0.37-0.04; P=0.11）。同样地，两组在急性下呼吸道感染，抗生素使用和非严重不良事件的其他症状方面均没有显着差异。

急性下呼吸道感染是初级保健中最常见的疾病之一。症状包括咳痰、胸痛、呼吸急促和喘息。患者也可以具有与哮喘加重相似的症状，例如气道炎症和呼气量减少。虽然类固醇对哮喘有效，但是在急性下呼吸道感染中使用的证据还不足，尽管它们越来越多地用于治疗下呼吸道感染。

结果表明，口服类固醇不适宜应用于本研究中包括的患者类型的急性下呼吸道感染；然而，关于他们在其他类型患者中的益处仍不能确定。

作者总结：“需要进一步的研究来确定具有更严重感染的初级保健患者的有效性，例如具有CRP升高或需要立即进行抗生素治疗的患者，并且需要较大的研究或荟萃分析来解决亚组中的影响。”

http://www.medscape.com/viewarticle/884561

原文

No Benefit for Oral Steroids inLower Respiratory Tract Infection

Oral steroids do not reduce symptomseverity or duration for nonasthmatic adults with acute lower respiratory tractinfection when compared with placebo, a study found.

"This trial suggests that oralcorticosteroids should not be used in adult primary care patients withoutasthma or chronic obstructive pulmonary disease who do not require treatmentwith an immediate antibiotic," the researchers write.

Alastair G. Hay, FRCGP, from theUniversity of Bristol, United Kingdom, and colleagues published their findingsin the August 22/29 issue of JAMA.

The randomized, placebo-controlled trialtook place at 54 family practices in England between July 2013 and October2014. It included 401 adults whose mean age was 47 years, and who were 63%women and 17% smokers. Participants had acute cough and at least one lowerrespiratory tract symptom that did not need immediate antibiotic treatment.They had no history of chronic obstructive pulmonary disease or need for asthmamedication within the last 5 years.

The researchers randomly assignedparticipants to receive oral prednisolone tablets (n=199)40mg/day or matchedplacebo(n=202) once daily for 5 days.

Participants measured their peakexpiratory flow twice daily for 28 days or until symptoms cleared. Theyreported cough symptoms for 28 days beyond that.

Analyses adjusted results for age, sex,influenza vaccine, smoking, and possible differences in baseline factors.

Both groups had similar median durationof moderately bad or worse cough, at about 5 days in both groups (fullyadjusted hazard ratio, 1.09; 95% confidence interval, 0.87-1.37; P=.44).

The prednisolone group had slightlylower median symptom severity than placebo (scale, 1-6), but the results werenot significant when adjusted for potential confounders (1.99 vs 2.16; fullyadjusted, −0.17; 95% confidence interval, −0.37 to 0.04; P=.11).

Likewise, the two groups showed nosignificant differences for other symptoms of acute lower respiratory tractinfection, antibiotic use, and nonserious adverse events.

The authors note several studylimitations. Providers selected which patients could participate, andparticipants self-reported their symptoms, which may have biased the study.Adherence was not measured, although a similar lack of effect and similaradverse events suggests little difference in adherence between the two groups.

Acute lower respiratory tract infectionrepresents one of the most commonly seen conditions in primary care. Symptomsinclude sputum, chest pain, shortness of breath, and wheeze. Patients can alsohave symptoms similar to an asthma exacerbation, such as airway inflammationand reduced forced expiratory volume. Although steroids are effective inasthma, insufficient evidence exists for their use in acute lower respiratorytract infection, even though they are increasingly used for this purpose.

The results suggest oral steroids shouldnot be used to treat acute lower respiratory tract infection in the type ofpatients included in this study; however, questions remain about their benefitsin other groups of patients.

"Further research is needed toestablish effectiveness in primary care patients with more severe infections,such as those with elevated C-reactive protein levels or requiring immediateantibiotic treatment, and larger studies or meta-analysis are needed to addresseffects in subgroups," the authors conclude.

The study was funded by NationalInstitute for Health Research School for Primary Care Research. One coauthorreports receiving funding from Alere Inc and Roche Molecular Diagnostics and isa cofounder of Phoresa Inc, which is developing point-of-care tests for primarycare.

http://www.medscape.com/viewarticle/884561

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图文编辑：宋小船

审稿：陈文森 卢先雷

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