地塞米松与强的松在儿童哮喘急性发作中的疗效比较
2018/01/15
摘要
遵循现行指南，哮喘急性发作建议使用全身皮质激素。既往研究提示在急诊室给予全身皮质激素患者住院率和临床指标均有显著改善。尽管既往推荐强的松和其他相关口服制剂，研究者就地塞米松作为可替代药物进行观察，因地塞米松具有更长的半衰期和改良的口感。纳入多个小样本临床研究和2个较大临床研究的系统性综述提示在急诊室给予强的松和地塞米松疗效相当，无论给药方式为肌注还是口服。与强的松相比，急诊室给予口服地塞米松胃肠道呕吐反应明显降低，再次给药即24-48小时以后也同样如此。评价单次给予地塞米松研究提示随访期患者病情好转程度相似，但部分研究提示与不同剂量强的松相比，患者症状增加且需要更多的皮质激素。进一步研究可以评价地塞米松剂量、剂型，给药频率，并测定相关药物副作用，例如行为改变。有鉴于哮喘人群基线情况存在异质性，出现哮喘急性发作则可以结合设计探究地塞米松最佳治疗方案。
Abstract
Systemic corticosteroids are recommended in clinical practice guidelines for the treatment of acute asthma exacerbation based on evidence demonstrating reduced hospitalizations and improved outcomes after administration in the emergency department. Although prednisone and related oral preparations have been recommended previously, researchers have assessed dexamethasone as an alternative based on its longer biologic half-life and improved palatability. Systematic reviews of multiple small trials and 2 larger trials have found no difference in revisits to the emergency department compared to prednisone for dexamethasone given either as an intramuscular injection or orally. Studies of oral administration have found reduced emesis for dexamethasone compared to prednisone both in the emergency department and for a second oral dose, typically given 24 to 48 hours later. Studies assessing a single dose of dexamethasone have found equivalent improvement at follow-up but with some evidence of increased symptoms and increased need for additional corticosteroids compared to multiple doses of prednisone. Future research could further assess dexamethasone dose, formulation, and frequency and measure other related adverse effects such as behavior change. Consideration of baseline differences within the heterogeneous population of children requiring acute care for asthma may also guide the design of an optimal dexamethasone regimen.
遵循现行指南，哮喘急性发作建议使用全身皮质激素。既往研究提示在急诊室给予全身皮质激素患者住院率和临床指标均有显著改善。尽管既往推荐强的松和其他相关口服制剂，研究者就地塞米松作为可替代药物进行观察，因地塞米松具有更长的半衰期和改良的口感。纳入多个小样本临床研究和2个较大临床研究的系统性综述提示在急诊室给予强的松和地塞米松疗效相当，无论给药方式为肌注还是口服。与强的松相比，急诊室给予口服地塞米松胃肠道呕吐反应明显降低，再次给药即24-48小时以后也同样如此。评价单次给予地塞米松研究提示随访期患者病情好转程度相似，但部分研究提示与不同剂量强的松相比，患者症状增加且需要更多的皮质激素。进一步研究可以评价地塞米松剂量、剂型，给药频率，并测定相关药物副作用，例如行为改变。有鉴于哮喘人群基线情况存在异质性，出现哮喘急性发作则可以结合设计探究地塞米松最佳治疗方案。
（上海交通大学医学院附属瑞金医院呼吸与危重症医学科 周剑平 万欢英 摘译）
（Pediatr Emerg Care. 2018 Jan;34(1):53-58. doi: 10.1097/PEC.0000000000001371.）
Dexamethasone Compared to Prednisone for the Treatment of Children With Acute Asthma Exacerbations.
Pediatr Emerg Care. 2018 Jan;34(1):53-58. doi: 10.1097/PEC.0000000000001371.
Abaya R, Jones L, Zorc JJ.Abstract
Systemic corticosteroids are recommended in clinical practice guidelines for the treatment of acute asthma exacerbation based on evidence demonstrating reduced hospitalizations and improved outcomes after administration in the emergency department. Although prednisone and related oral preparations have been recommended previously, researchers have assessed dexamethasone as an alternative based on its longer biologic half-life and improved palatability. Systematic reviews of multiple small trials and 2 larger trials have found no difference in revisits to the emergency department compared to prednisone for dexamethasone given either as an intramuscular injection or orally. Studies of oral administration have found reduced emesis for dexamethasone compared to prednisone both in the emergency department and for a second oral dose, typically given 24 to 48 hours later. Studies assessing a single dose of dexamethasone have found equivalent improvement at follow-up but with some evidence of increased symptoms and increased need for additional corticosteroids compared to multiple doses of prednisone. Future research could further assess dexamethasone dose, formulation, and frequency and measure other related adverse effects such as behavior change. Consideration of baseline differences within the heterogeneous population of children requiring acute care for asthma may also guide the design of an optimal dexamethasone regimen.
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布地奈德/福莫特罗维持及缓解策略勇于青少年哮喘人群
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免疫治疗在儿童哮喘的系统性综述证据：GRADE系统性综述
