糖皮质激素在重症肺炎中的炎症调节作用探讨

A Discussion of Glucocorticoid on the Regulation of Inflammation in Severe Pneumonia

目的:探讨糖皮质激素在重症肺炎中的炎症调节作用,为合理应用糖皮质激素提供依据。方法:收集2016年1月-2017年12月在我院呼吸科住院的重症肺炎患者68例,随机将患者分为对照组33例和激素组35例。对照组给予常规治疗,激素组在常规治疗的基础上静脉注射甲泼尼龙琥珀酸钠治疗,分别在治疗前、治疗第6天、治疗第8天检测重症肺炎患者内源性皮质醇水平、补体水平和C-反应蛋白水平。结果:治疗后两组的内源性皮质醇水平和补体C3水平较治疗前升高,C-反应蛋白水平较治疗前降低,且激素组与对照组比较,差异均有统计学意义(P<0.05);激素组治疗第8天与第6天指标进行比较,差异无统计学意义(P>0.05),对照组治疗第8天与第6天指标进行比较,差异无统计学意义(P>0.05)。结论:在重症肺炎的早期,患者体内内源性皮质醇水平和补体C3水平下降,C-反应蛋白水平升高,使用糖皮质激素可以显著改善其水平,而且短程使用可能临床更能获益。

Objective：To explore the role of glucocorticoid in inflammatory regulation in severe pneumonia and provide evidence for rational application of glucocorticoid.Methods：Collect the sample of 68 patients with severe pneumonia who were admitted to the respiratory department of our hospital from January 2016 to December 2017.The patients were randomly divided into control group（33 patients）and glucocorticoid group（35 patients）.The control group was given routine treatment and the glucocorticoid group was treated by intravenous injection of methylprednisolone sodium succinate on the basis of routine treatment.The levels of endogenous cortisol,complement and C-reactive protein in patients with severe pneumonia were detected before the treatment and on the 6 th day,the 8 th day respectively.Results：After treatment,the endogenous cortisol levels and complement C3 levels in both groups were higher than before treatment,and C-reactive protein level was lower than before treatment.There were statistically significant differences between the glucocorticoid and the control group（P〈0.05）.No significant difference was observed between the 8 th day and the 6 th day in the glucocorticoid group（P〈0.05）.The control group was compared in the 8 th and 6 th day,and there was no significant difference（P〈0.05）.Conclusion：In the early stages of severe pneumonia,the levels of endogenous cortisol,complement C3 decreased and C-reactive protein increased.The use of glucocorticoid significantly improved their levels,and short-range use was likely to be more beneficial.