糖皮质激素治疗慢性阻塞性肺疾病急性加重期的疗效观察

Effect of corticosteroids on the course of therapy and acute exacerbations again in AECOPD patients

目的:观察糖皮质激素治疗慢性阻塞性肺疾病急性加重期(AECOPD)的效果。方法:采用回顾性病例对照研究,选取2017年1月—2019年12月我院收治的AECOPD患者502例,根据住院期间使用糖皮质激素与否,分为激素组463例、未用激素组39例,比较两组抗感染天数、住院时间、再次住院间隔时间、真菌感染发生率。激素组使用激素未超过2周,对其再细分为吸入激素(ICS)、全身用激素、ICS+全身用激素三个亚组,比较各组上述指标有无差异。结果:激素组再次加重住院间隔时间短于未用激素组,差异有统计学意义(P<0.05);两组抗感染天数、住院时间、真菌感染发生率无显著差异(P>0.05)。在激素组用药方式方面,ICS组和全身用激素组比较,全身用激素组和ICS+全身用激素组比较,抗感染天数、住院时间、再次加重住院间隔时间、真菌感染发生率均无显著差异(P>0.05)。ICS组抗感染天数及住院时间均短于ICS+全身用激素组,差异有统计学意义(P<0.05);而两组间再次加重住院间隔时间、真菌感染无显著差异(P>0.05)。结论:短期使用糖皮质激素不会增加真菌感染率;使用糖皮质激素可能导致COPD患者再次急性加重时间缩短;同时使用ICS及全身激素可能延长患者抗感染疗程及住院时间。

Objective To investigate whether the use of corticosteroids in the treatment of AECOPD patients has an impact on the anti-infection treatment course,hospital stay,re-acute exacerbation hospitalization interval,and fungal infection.Methods 502 patients with AECOPD admitted to our hospital from January 2017 to December 2019 were selected.According to the use of hormones during hospitalization,they were divided into hormone group(463 cases)and non-hormone group(39 cases),and the anti-infection days,length of stay,time between re-hospitalization,and fungal infection were compared between the two groups.The hormone group was subdivided into inhalation hormone(ICS),systemic hormone(ICS)and ICS+systemic hormone(ICS)subgroups for less than 2 weeks.Results The interval between relapse and hospitalization in hormone group was shorter than that in non-hormone group,and the difference was statistically significant(P<0.05).There were no significant differences in anti-infection days,hospital stay and fungal infection between the two groups(P>0.05).There were no significant differences in anti-infection days,length of hospital stay,time between re-aggravation of hospital stay and fungal infection between ICS group and ICS+systemic hormone group(P>0.05).The anti-infection days and hospital stay in ICS group were shorter than those in ICS+systemic hormone group,and the difference was statistically significant(P<0.05),but there were no significant differences between the two groups in the time between re-aggravation of hospital stay and fungal infection(P>0.05).Conclusions Short-term hormone use did not increase the risk of fungal infection.Hormone use may shorten the time for relapse of acute exacerbation in copd patients.Concurrent use of ICS and systemic hormones may prolong the duration of anti-infective treatment and hospital stay.