糖皮质激素在支气管肺发育不良防治中的应用与困惑

Glucocorticoid for prevention and treatment of bronchopulmonary dysplasia:Application and confusion

支气管肺发育不良(bronchopulmonary dysplasia,BPD)是早产儿的常见并发症。糖皮质激素治疗是防治BPD的手段之一,但亦可导致近期或远期并发症,临床尚缺乏公认兼具有效性和安全性的成熟给药方案。现有的证据显示,生后晚期(>7 d)全身使用低剂量、短疗程糖皮质激素可起到防治BPD的作用;生后早期(≤7 d)给予氢化可的松也可能减少BPD的发生,但仍需要进一步的密切随访以明确远期神经系统不良预后事件。早期雾化吸入或以肺表面活性物质为载体气道内注入糖皮质激素是新近提出的给药方案,但仍需要更多的临床数据及随访结果印证该方案的优缺点。进行设计严谨的、多中心随机对照研究以确立最佳给药方案,明确糖皮质激素剂型、药物及给药时机对于BPD的防治极为重要。

Bronchopulmonary dysplasia(BPD)is a common complication in preterm infants. Corticosteroid is one of the choices for both the prevention and the treatment for BPD.However,short or long-term adverse outcomes were reported in different studies. Hence,there is no recommendation for the "best" medication strategy of corticosteroid. Current evidence shows that low-dose and short course of systemic corticosteroid shows effects in the prevention and/or the treatment of BPD in late postnatal periods(>7 days). Meanwhile,early(≤7 days)postnatal hydrocortisone therapy could reduce the incidence of BPD.Long-term neurodevelopment outcomes should be taken into concern before the conclusion is made. Besides,early inhaled or intratracheal instilled glucocorticoids(co-administrated with pulmonary surfactant)could be another choice. Further research is needed to confirm the advantages and disadvantages of this medication program. It is important to have carefully disigned multicenter randomized controlled trials in order to establish the best way of administration and clarify the dosage form,the drug and the timing for glucocorticoids.