糖皮质激素治疗慢性阻塞性肺疾病急性加重的研究进展

Research advances of corticosteroids in treatment of acute exacerbation of chronic obstructive pulmonary disease

全身使用糖皮质激素治疗慢性阻塞性肺疾病急性加重（AECOPD）的作用已得到肯定，但使用的剂量如何、使用多长时间、是否需要逐渐减量等还有争议。高剂量、中剂量和低剂量糖皮质激素均可改善AECOPD患者临床症状、肺功能、缩短住院时间，考虑到其安全性和有效性临床应用以低剂量短疗程为宜，如泼尼松40mg口服qd，共10d。临床医师通常采用逐渐减量的停药方法，但实际上多数情况下并不需要。糖皮质激素雾化吸入可以替代全身应用治疗AECOPD。有关糖皮质激素治疗AECOPD的最佳用药方案如用药途径、剂量、时间、是否逐渐减量等尚需进一步研究。

Systemic corticosteroids are used to treat acute exacerbation of chronic obstructive pulmonary disease （AECOPD）, this common clinical practice has been endorsed by medical societies. However,the most appropriate regimen such as dosage,how long and tapering remains controversial. Low-, medium- and high-dose corticosteroids can improve clinic symptom and lung function,shorter length of stay. Efficacy and safety data support the use of low-dose corticosteroids regimens such as prednisone 40 mg orally once a day for 10 days. Tapering of corticosteroids regimens, although a common practice,is unnecessary in most circumstances. Nebulized corticosteroids may be an alternative to systemic corticosteroids in the treatment of AECOPD. Further studies are needed to clarify the optimal corticosteroids regimens for AECOPD such as administration, dosage, period and tapering.