糖皮质激素在社区获得性肺炎中的临床价值:循证医学视角下的争议与共识
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The clinical value of glucocorticoids in community-acquired pneumonia: controversy and consensus from the perspective of evidence-based medicine
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    摘要:

    社区获得性肺炎在我国仍具有较重的疾病负担,重症患者因过度炎症反应常导致治疗失败。糖皮质激素作为辅助治疗,通过多种机制抑制炎症因子、减轻细胞因子风暴,在重症患者中显示出降低死亡率、缩短机械通气时间等临床获益。然而,其对非重症患者疗效不明确,且可能增加高血糖、继发感染等风险。当前国内外指南均建议仅将糖皮质激素用于重症社区获得性肺炎,并需个体化评估获益与风险。未来研究需进一步明确最有可能受益的患者、最佳药物剂量和治疗持续时间、联合治疗方案,并持续关注新循证更新。

    Abstract:

    Community-acquired pneumonia (CAP) still has a heavy disease burden in our country. Severe patients often fail to receive treatment due to excessive inflammatory response. As an adjunctive therapy, glucocorticoids inhibit the inflammatory cytokines and attenuate the cytokine storm through multiple mechanisms. It has demonstrated clinical benefits in severely ill patients such as reduced mortality and shortened duration of mechanical ventilation. However, their efficacy remains uncertain in non-severe CAP patients. It may increase the risks of hyperglycemia and secondary infections. Current domestic and international guidelines recommend that glucocorticoids can be used only for severe CAP. The benefits and risks require individualized assessment. Future research needs to further clarify the patients most likely to benefit, the optimal drug dose, and duration of treatment as well as combination therapy options. It also needs continuously to monitor the new evidence.

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王潇,张静.糖皮质激素在社区获得性肺炎中的临床价值:循证医学视角下的争议与共识[J].实用医院临床杂志,2025,22(6):22-26

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  • 在线发布日期: 2025-12-11
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