短程皮质激素疗法在慢性阻塞性肺疾病急性加重中的应用

Application of short-term glucocorticoid therapy in acute exacerbation of chronic obstructive pulmonary disease

目的：观察短程全身皮质激素对于慢性阻塞性肺疾病急性加重的有效性及安全性。方法将86例慢性阻塞性肺疾病急性加重患者随机分为短程全身皮质激素治疗组及标准激素治疗组,短程组给予甲泼尼松龙40 mg,1次/d,静脉滴注,疗程5 d,标准组给予泼尼松30 mg,1次/d,口服,疗程10～14 d,之后逐渐减量至停药,比较两组治疗后临床症状CAT评分、肺功能、血气分析、住院时间、治疗成功率,随访并比较两组一年内再次急性加重情况,比较两组治疗后餐后血糖、促肾上腺皮质激素水平。结果两组治疗后肺功能改善程度、治疗成功率及一年内再次急性加重发生率比较差异无统计学意义（P〉0.05）；短程组CAT评分、血气分析改善明显优于标准组,且住院时间更短,治疗结束后餐后血糖更低,促肾上腺皮质激素水平影响更小,差异有统计学意义（P〈0.05）。结论5 d短程全身皮质激素疗法安全有效,可优化慢性阻塞性肺疾病急性加重的激素治疗策略。

Objective To observe the availability and safety of short-term glucocorticoid therapy in acute exacerbation of chronic obstructive pulmonary disease. Methods 86 cases of patients with acute exacerbation of chronic obstructive pulmonary disease were randomly divided into short-term group and standardterm group which was given methylpred-nisolone 40 mg perday for 5 days through intravenous and prednisone 30 mg orally perday for 10-14 days respec-tively,after the tapered to discontinuation.The indices including CAT score,lung function,blood gas analysis,length of stay in hospital and therapy achievement rate was compared between two groups after treatment finished respectively. All cases were followed up for 1 year and the reexacerbation rate was compared between two groups also.At the meantime,postprandial blood sugar and adrenocorticotrophic hormone was also compared between two groups after treatment finished respectively. Results There was no statistical difference in lung function indices,therapy achievement rate and reexacerbation rate between two groups respectively（P〉0.05）.But a lower CAT score,a better blood gas index,a shorter length of stay in hospital,a lower postprandial blood sugar and a higher ACTH level was observed respectively in shortterm group than that in standard-term group（P〈0.05）. Conclusion With an excellent availability and security,strategy of 5 days glucocorticoid method is better for acute exacerbation of chronic obstructive pulmonary disease therapy.