糖皮质激素治疗严重急性呼吸综合征初探

Use of glucocorticoid in treatment of severe acute respiratory syndrome cases

目的 探讨糖皮质激素在严重急性呼吸综合征 (SARS)治疗中的作用。方法 对 2 0 0 3年 3月至 5月在本院收治的 70例SARS患者进行分析。结果 (1) 70例患者治愈出院 6 3例 ,死亡 7例 ,平均住院 16 9d。 (2 )激素治疗 :11例未接受激素治疗 ,平均住院 16 8d ;5 9例采用甲泼尼龙 4 0～ 6 4 0mg/d ,其中小剂量组 2 3例 ,4 0～ 80mg/d ,平均住院 15d ;中剂量组 2 7例 ,治疗剂量 12 0～ 2 4 0mg/d ,平均住院 18 5d ;大剂量组 9例 ,32 0～ 6 4 0mg/d ,平均住院 17 9d。 结论 早期、适量使用糖皮质激素能明显改善SARS患者的临床症状 ,减轻病变进展程度 ,加快肺部病变的吸收。但目前的数据显示 ,使用糖皮质激素不能缩短住院时间。

Objective To explore the effect of glucocorticoid in the treatment for severe acute respiratory syndrome (SARS). Methods Clinical data of 70 patients with SARS admitted to Youan Hospital in Beijing during March to May, 2003 were analyzed. Results (1) Sixty-three of 70 cases of SARS recovered and seven cases died, with a case-fatality ratio of 10%. (2) Average length of hospital stay was 16.9 days for the all 70 cases, and 16.8 days for the 11 cases without glucocorticoid treatment, without statistical significance ( F =1.018, P =0.39). (3) The other 59 cases were administered with 40 mg to 640 mg of methylprednisolone daily. (4) Average hospital stay was 15 days for the 23 cases with lower dose of 40 mg to 80 mg methylprednisolone daily, 18.5 days for the 27 cases with medium dose of 120 mg to 240 mg daily, and 17.9 days for the nine cases with higher dose of 320 mg to 640 mg daily ( F =1.018, P =0.39). Conclusions Earlier use of glucocorticoid therapy with suitable doses could alleviate their clinical symptoms, improve their clinical courses, and promote the absorbance of infiltration in their lungs on chest-X-ray films for the cases with SARS. However, current clinical data showed that glucocorticoid theraoy could not shorten the length of hospitalization for the cases with SARS.