短程低剂量甲泼尼龙抑制ARDS炎症因子及其作用机制研究

目的：探讨短程低剂量甲泼尼龙辅助治疗急性呼吸窘迫综合征(ARDS)的疗效、安全性及其对患者炎症因子的影响。方法选择2013年2月至2015年1月中南大学湘雅医学院附属海口医院重症监护室收治的ARDS患者49例为研究对象，应用随机数字表法将患者分为A组23例和B组26例。A组患者给予常规治疗，B组在常规治疗的基础上加用低剂量甲泼尼龙80 mg/d，qd静脉滴注，连续应用5 d。比较两组患者的病死率、住院时间、APACHEⅡ评分、氧合指数及炎症因子C反应蛋白和降钙素原水平。结果 A、B两组患者病死率分别为21.74%和3.85%，B组低于A组但差异无统计学意义(P>0.05)；两组患者治疗后的APACHEⅡ评分均明显降低，且B组治疗后下降比A组更明显，差异均有统计学意义(P<0.05)；治疗后A、B组氧合指数分别为(311.2±35.6) mmHg和(405.8±41.2) mmHg，B组明显高于A组，差异有统计学意义(P<0.05)；治疗7 d后A、B两组患者C反应蛋白分别为(56.3±9.6) mg/L和(15.3±12.1) mg/L，降钙素原分别为(2.5±1.6)μg/L和(1.3±0.9)μg/L，B组C反应蛋白和降钙素原均明显低于A组，且差异有统计学意义(P<0.05)；两组患者用药期间未观察到明显药物相关不良反应。结论短程低剂量甲泼尼龙可通过抑制ARDS患者炎症反应，提高临床疗效。

Inhibitory effect of short-term low-dose methylprednisolone on the inflammation factors of acute respiratory distress syndrome and its mechanism

Objective To assess the clinical efficacy and safety of short-term low-dose methylprednisolone for adjuvant treatment of acute respiratory distress syndrome (ARDS) and its effect on the inflammatory factors. Methods Forty-nine patients with ARDS were recruited from Haikou Hospital Affiliated to Xiangya School of Medicine, Central South University from Feb. 2013 to Jan. 2015, which were randomly divided into group A (n=23) and group B (n=26). Patients in group A were treated with routine treatment, and patients in group B were treated with routine treatment plus methylprednisolone 80 mg/d, qd ivggt for 5 days. The fatality rate, length of hospital stay, APACHEⅡscore, oxygenation index, and inflammation indexes (C-reactive protein and procalcitonin) were recorded. Results The fatality rate were 21.74%in group A and 3.85%in group B, with no statistically significant difference be-tween group A and group B (P>0.05). The APACHEⅡscore decreased significantly after treatment in the two groups (P<0.05), and the decrease in group B were more significant than that in group A (P<0.05). The oxygenation index were (311.2±35.6) mmHg in group A after treatment, which was significantly lower than (405.8±41.2) mmHg in group B (P<0.05). After 7 days of treatment, the C-reactive protein were (56.3 ± 9.6) mg/L in group A and (15.3 ± 12.1) mg/L in group B, and the procalcitonin were (2.5 ± 1.6)μg/L and (1.3 ± 0.9)μg/L, with statistically significant difference between the two groups (P<0.05). No obvious adverse drug associated events were found in the two groups. Conclusion Short-term low-dose methylprednisolone can improve the clinical efficacy in patients with ARDS by inhibiting the inflammation factors.