糖皮质激素辅助治疗老年干酪性肺炎的临床观察

Adjuvant therapy with glucocorticoid for caseous pneumonia in the elderly

摘要:

目的 探讨糖皮质激素辅助治疗老年干酪性肺炎的临床疗效和价值。方法 前瞻性纳入北京老年医院感染疾病科2015年1月至2016年8月92例老年干酪性肺炎患者；根据不同治疗方案随机分为观察组和对照组。观察组应用常规抗痨治疗加糖皮质激素；对照组仅用常规抗痨治疗。治疗4、6、8周后分别比较两组患者的临床症状、病变吸收及痰菌阴转等情况。应用SPSS 22.0统计软件进行数据分析,组间比较采用t检验或χ²检验。结果 观察组患者治疗4、6、8周后的临床主要症状好转率明显高于对照组(60.9% vs 28.3%, 73.9% vs 47.8%, 91.3% vs 71.7%; P<0.05),肺部病灶总体吸收较对照组快(52.2% vs 28.3%, 76.1% vs 45.7%, 95.7% vs 73.9%; P<0.05),但两组患者痰菌阴转率无明显差异(34.2% vs 40.5%, 60.5% vs 52.4%, 71.1% vs 73.8%; P>0.05)。结论 老年干酪性肺炎患者短期应用糖皮质激素是安全的,而且有益于肺部渗出炎症的吸收,可减轻结核临床中毒症状。

Abstract:

Objective To investigate the clinical efficiency and value of adjuvant therapy with glucocorticoid in the treatment of the elderly patients with caseous pneumonia. Methods A total of92 old patients with caseous pneumonia admitted in our department from January 2015 to August 2016 were enrolled in this study. According to their treatment regimens, they were divided into the observation and control groups. The control group was only treated with conventional anti-tuberculosis therapy, while the observation group was given adjuvant therapy with glucocorticoid. The clinical conditions, such as symptoms, lesions absorption, sputum negative conversion and so on, were compared between the 2 groups at 4,6, 8 weeks after the treatment. SPSS 22.0 software was used to perform the statistical awalysis. The data were compared with t test or Chi-square test. Results Compared with the control group, the main symptoms were more significantly alleviated in observation group in 4,6 and 8 weeks after treatment (60.9% vs 28.3%, 73.9% vs 47.8%, 91.3% vs 71.7%; P<0.05). The observation group had better total absorption of pulmonary lesions than the control group (52.2% vs 28.3%, 76.1% vs 45.7%, 95.7% vs 73.9%; P<0.05), but no difference was seen in the sputum negative conversion rates between the 2 groups (34.2% vs 40.5%, 60.5% vs 52.4%, 71.1% vs 73.8%; P>0.05). Conclusion Short term application of glucocorticoid is safe for the elderly patients with caseous pneumonia. It is also beneficial to the absorption of inflammation in the lungs and to the reliefs of tuberculosis symptoms.