糖皮质激素治疗腺病毒感染的不良反应及早期防治措施

Adverse reactions of methylprednisolone in the treatment of adenovirus-induced infection and measures of early prevention

目的探讨糖皮质激素甲强龙治疗腺病毒感染的不良反应,分析导致股骨头坏死的机制及早期综合防治的疗效。方法收集51例确诊为腺病毒感染患者,根据甲强龙单日最大剂量分组,分为≥320 mg组18例,<320 mg组33例,对病程中出现的不良反应进行统计学分析。测定2组三酰甘油、总胆固醇、低密度脂蛋白、血钙、血磷、D-二聚体,并进行统计学分析。≥320 mg组根据出现的异常指标,分别给予口服阿托伐他汀钙、皮下注射低分子肝素钠、口服华法林、前列地尔静滴、口服钙剂、骨化三醇和阿仑膦酸钠片等综合防治,治疗前后测定以上指标,进行统计学分析。结果≥320 mg组患者出现血脂异常、心动过速、电解质紊乱、继发真菌感染、血糖异常、撤药综合征等不良反应,与<320 mg组相比,总胆固醇、三酰甘油、低密度脂蛋白、血磷、D-二聚体升高,血钙下降。≥320 mg组治疗后与治疗前相比,总胆固醇、D-二聚体降低,血钙升高,血磷降低,甘油三酯、低密度脂蛋白降低。结论糖皮质激素治疗腺病毒感染是一把双刃剑,可能导致严重后果,临床诊治过程中要注意早期防治,减少后期出现股骨头坏死机率。

Objective To explore adverse reactions of methylprednisolone （MP） in the treatment of patients affected by adenovirus and mechanism involved in the osteonecrosis of femoral head （ONFH） and also to observe effects of early comprehensive prevention and treatment. Methods In accordance with the maximum MP daily dosage, 51 confirmed patients were divided into 2 groups ： the ≥320 mg/d group （n = 18 ） and the ≤320 mg/d group （n = 33 ）. Statistical analysis was made on the adverse drug reactions that occurred in the course of treatment. Levels of triaglyceride, total cholesterol, low density lipoprotein cholesterol, blood calcium, serum phosphate, D-Dimer and blood glucose in the patients of both groups were analyzed statistically. For the ≥320 mg/d group, such interventions as oral application of calcium atrovopine, warfarin, calcium, calcitriol and phosphonate pills, injection of low molecular heparin sodium, and intravenous dripping of Prostin-VR were implemented for comprehensive prevention and treatment. Levels of the above data were detected and statistical analyses were made accordingly. Results Adverse reactions, such as dyslipidemia, tachycardia, electrolyte disturbance, secondary fungus infection, pathoglycemia and drug withdrawal syndrome were displayed in the patients of the ≥ 320 mg/d group. When compared with the patients of the ≤320 mg/d group, the levels of total cholesterol, triglycerides, low density lipoprotein cholesterol, serum phosphate and D-Direct were all increased, but the level of serum calcium was decreased （P 〈 0.05 ）. For the patients in the ≥ 320 mg/d group, the levels of total cholesterol and D-Dimer were decreased, the level of serum calcium was increased and that of serum phosphate was decreased （P 〈 0.01 ）. The levels of triaglyceride and low density lipoprotein cholesterol were also decreased （P 〉 0.05 ）. Conclusion Methylprednisolone, a double-edged sword in the treatment of adenovirus pneumonia, could bring about serious consequences. Measures should be taken for early prevention and treatment of possible adverse reactions in the course of clinical diagnosis and treatment of the disease, so as to reduce the probability of ONFH.