全身性類固醇治療慢性阻塞性肺疾病急性發作的最佳治療劑量－文獻回顧暨實證醫學證據

Optimal Dosage of Systemic Corticosteroid for COPD with Acute Exacerbation-Evidence-Based Review

葉金水(Chin-Shui Yeh) ； 林慶雄(Ching-Hsiung Lin) ； 陳正雄(Cheng-Hsiung Chen) ； 林國川(Kwo-Chuan Lin)

《內科學誌》 19卷5期 (2008/10) Pp. 387-393

https://doi.org/10.6314/JIMT.2008.19(5).02

摘要

短期全身性類固醇是慢性阻塞性肺疾病(COPD)急性發作時對中度及重度病患之標凖療法，數個前瞻性隨機對照臨床試驗顯示了全身性類固醇治療之臨床效益。然而對其最適治療劑量至今仍未有定論。大部分臨床試驗比較全身性類固醇與安慰劑之效果，並無直接比較低、中、高不同劑量之療效。全身性類固醇明顯改善FEV1(Forced Expiratory Volume in 1 second)及低血氣(PaO2)並且縮短平均住院日數。全身性類固醇治療之副作用與使用之劑量及期間長短有關，最常見的併發症是高血糖，可發生於高、中到低劑量之全身性類固醇治療。至於嚴重之感染併發症，多發生於高劑量且長時間之治療，然而續發感染之發生率在類固醇使用組及對照組之問並無顯著差異。基於療效、安全與副作用之考量，現今”The Global Initiative for Chronic Obstructive Lung Disease (GOLD)”臨床治療指引對治療COPD急性發作建議使用低劑量30-40 mg prednisolone口服每天一次7-10天。延長治療期間並不能得到更大益處反而會增加副作用之危險。

關鍵字

慢性阻塞性肺疾病 ； 急性發作 ； 皮質類固醇 ； 實證醫學

並列摘要

Short term therapy of systemic corticosteroids is the standard treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD). Several prospective randomized controlled trials demonstrated the clinical benefits of systemic corticosteroids to patients of COPD with acute exacerbation. However, the most optimal dosage regimen of systemic corticosteroid remains controversial. Most trials compared the effects of systemic corticosteroid and placebo without directly comparing medium-, high-, and low-dose regimens. Systemic corticosteroids improved the FEV1 (Forced Expiratory Volume in 1 second) and the partial pressure of oxygen (PaO2) significantly. The average length of stay in hospital was also shorter with the use of corticosteroid. Systemic corticosteroid use is associated with several adverse effects that are dose or duration dependent. Hyperglycemia is most common side effect ranging from low to high dose of steroid. Reported rates of secondary infection did not differ significantly among the corticosteroid and placebo, but the eight-week glucocorticoid group had the highest proportion of patients with serious infections. Based on efficacy, safety and adverse effects, the clinical guideline of American Thoracic Society (ATS) and European Respiratory Society (ERS) recommend the low dose corticosteroid regimens such as prednisone 30 to 40 mg orally once/day for 7-10 days in most patients with an acute exacerbation of COPD.

並列關鍵字

Chronic obstructive pulmonary disease, COPD ； Acute exacerbation ； Corticosteroid ； Evidence-based medicine