糖皮质激素治疗重症急性呼吸综合征初探

Glucocorticoid in the treatment of severe acute respiratory syndrome patients:a preliminary report

目的 探讨糖皮质激素对重症急性呼吸综合征 (SARS)病情的影响。方法 定期观察我院自 2 0 0 3年 3月 2 6日至 5月初收治的SARS病人 30例 ,病程均为 3周以上。统计激素治疗的时间和剂量 ,观察治疗前后CD+ 4 、CD+ 8、CD+ 3 T淋巴细胞计数 ,以及电解质、血象、血清白蛋白变化。结果 激素治疗前 2 7例患者CD+ 4 、CD+ 8、CD+ 3 T淋巴细胞计数分别为 (个 / μl ) 4 0 1± 2 0 3、340± 187、75 6± 383。30例中 2 9例使用甲泼尼龙治疗 ,2 4例剂量为 80～ 16 0mg/d ,最大剂量为 10 0 0mg/d(入我院前 )。应用激素后血白细胞升高 (P <0 .0 1) ;血K+ 、Na+ 、Cl-无明显变化 (P >0 .0 5 ) ;血糖升高 (P =0 .0 1) ;血清白蛋白明显下降 (P <0 .0 1) ;较大剂量的激素可明显抑制CD+ 4 、CD+ 8、CD+ 3 T淋巴细胞的水平 ;3例重症病例在大剂量激素应用下出现二重感染。结论 SARS病人在病程早期免疫功能已受到抑制 ,大剂量应用糖皮质激素可明显加重这一抑制 ,并使机体处于高代谢状态 (血糖升高、血清白蛋白下降 ) ,进一步导致病情加重 ,病人在后期易出现严重继发感染 ,因此应严格掌握激素适应证 ,不宜大剂量使用。

Objective To discuss the effect of glucocorticoid (methylprednisolone) on severe acute respiratory syndrome (SARS). Methods Thirty SARS patients were treated at our hospital for over 3 weeks since March to May 2003. The course and dosage of glucocorticoid, counts of CD +_4, CD +_8 and CD +_3, electrolytes, blood routine, and sera albumin before and after the treatment were analysed. Results Before treatment by methylprednisolone, the counts of CD +_4, CD +_8 and CD +_3 of 27 SARS patients were (401±203), (340±187),(756±383) cells/μl. Twenty-nine of the 30 SARS patients were treated by methylprednisolone. The dosage for 24 patients was 80-160 mg/d with the largest being 1 000mg/d before admission to the hospital. The count of WBC was increased after treatment ( P <0.01). No obvious effect was observed on the potassium, sodium and chlorine of blood ( P >0.05). Glucocorticoid increased the level of blood glucose ( P =0.01), decreased the level of sera albumin( P <0.01), and its large dosage decreased the counts of CD +_4?CD +_8 and CD +_3. Three severe patients had secondary infection after administration of a large dose of glucocorticoid. Conclusions In the early stage of the disease, the counts of CD +_4?CD +_8 and CD +_3 of SARS patients may reduce markedly indicating the immunity is suppressed. A large dose of glucocorticoid may aggravate the suppression and make the body in an active metabolic state (the increase of blood glucose and the decrease of sera albumin). Thus the disease is aggravated and patients are likely to suffer from severe secondary infection. Indications for use of glucocorticoid must strictly controlled and its large dosage is improper.