摘要
目的 :探讨严重急性呼吸综合征 (severeacuterespiratorysyndrome,SARS)治疗中糖皮质激素 (glucocorti costeroids ,GCS)的使用与不良反应的关系。方法 :收集北京市SARS病历资料 ,建立数据库 ,回顾分析 12 91例临床诊断SARS病例。按照GCS起始剂量、日最大剂量和累积剂量分组 ,均换算为甲泼尼龙 (methyprednisonlone,MP)剂量。使用SAS 8.10软件统计GCS相关不良反应 ,包括血糖增高 (≥ 7.8mmol/L)、低钾血症 (<3.5mmol/L)、低钙血症 (<2 .12mmol/L)、收缩压升高 [≥ 14 0mmHg(1mmHg =0 .133kPa) ]及舒张压升高 (≥ 90mmHg)。结果 :GCS组 10 84例 ,未用GCS组 2 0 7例。GCS平均日使用剂量总趋势是递减 ,早期日平均剂量 (中位数 )为 16 0mg/d ,10天后下降 ,13天降到 80mg/d。GCS组病程中最高血糖 (8.6 8± 4 .80 )mmol/L ,未用GCS组 (6 .39± 3.71)mmol/L ,两组比较差异有显著性 (P <0 0 0 1)。MP起始 ≥ 80mg/d ,MP最大 ≥ 16 0mg/d以及MP累积 ≥ 30 0 0mg各组的平均血糖均明显升高。使用GCS后第 1～ 2周血糖升高最显著 ,而后逐渐下降。MP累积 ≥ 30 0 0mg组血糖增高且持续时间延长 ,与其它组比较差异有显著性 (P <0 .0 5 )。GCS组病程中最低血钾为 (3.6 6± 0 .5 0 )mmol/L ,低钾持续时间 1(1,75 )天 ,与?
Objective: To analysis the relationship between glucocorticosteroids (GCS) usage and side effects in the treatment of severe acute respiratory syndrome (SARS). Methods: All clinical records of probable SARS patients in Beijing were collected and input into an Epi6 database, in which 1 291 patients had entire information and met the clinical criteria of SARS. The usage of GCS and GCS associated side effects were analyzed retrospectively. Results: Patients accepted GCS therapy were 83.96% (n= 1 084), whereas 16.04%(n=207) did not take GCS. The average dosage of GCS was 160 mg/d in the first week, and then reduced to 80 mg/d and 40 mg/d in the second and the third weeks, respectively. Initial blood glucose, systolic pressure (SBP), and diastolic pressure (DBP) were no significant difference between GCS group and non-GCS group. The highest blood glucose during the treatment in GCS group was markedly higher than that in non-GCS group [(8.68± 4.80 ) mmol/L vs (6.39±3.71) mmol/L, P<0.05)]. The highest blood glucose and average blood glucose after initiation of GCStherapy were elevated in GCS group.The levels of blood glucose were correlated with the initial, maximum, and cumulative GCS dosages. Average blood glucose was increased markedly in groups with MP Initial ≥ 80 mg/d (Methyprednisonlone) , MP Maximal ≥160 mg/d, or MP Cumulative ≥3 000 mg. The blood glucose grew up significantly in the first and the second weeks in the treatment with GCS, and then returned to normal level gradually. Hyperglycemia duration in the group with MP Cumulative ≥3 000 mg persisted longer than that in the other groups(P<0.05). The lowest serum potassium during the treatment and the duration of hypokalemia in GCS group were significantly different from that in non-GCS group [(3.66±0.50) mmol/L vs (4.01±0.51) mmol/L, P<0.001 ;1(1,75)days vs 1(1,9)days, P<0.05, respectively].Average serum potassium and the duration of hypokalemia were related to the dosages of GCS. Serum potassium reached its nadir in the first week of GCS treatment and then grew up in the second week. In groups with MP Initial ≥320 mg/d,MP Maximal ≥320 mg/d, and MP Cumulative ≥3 000 mg,the level of serum potassium was lower and the duration of hypokalemia was longer than that in other groups. They began to returned to normal level in the third week. Administration of GCS prolonged the time of hypocalcemia[19(1,74)days in GCS group vs 8(1,32)days in non-GCS group,P<0.05]. The duration of hypocalcemia was prolonged according to the increasing of the maximal or the cumulative dosage of GCS. However, the duration of hypocalcemia in group with MP Cumulative <999 mg was similar to that in non-GCS group (P>05). After GCS administration, SBP and DBP were increased gradually, and reached their peaks in the fourth week [SBP (117.2±14.0) mm Hg and DBP (72.5±9.1) mm Hg vs SBP (120.0±12.5) mm Hg and DBP (74.5±8.7) mm Hg, P<0.05,1 mm Hg=0.133 kPa].Conclusion: Hyperglycemia and hypokalemia are correlated with GCS dosage and duration. Administration with GCS influences SBP, DBP, and duration of hypocalcemia. Appropriate low dosage of GCS (MP Initial and MP Maximal <159 mg/d, MP Cumulative <2 999 mg) causes few changes of blood glucose, serum potassium, and blood calcium. It is important to monitor laboratory findings during the treatment with GCS.
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2004年第5期519-524,共6页
Journal of Peking University:Health Sciences
基金
国家高技术研究发展计划专项经费 ( 2 0 0 3AA2 0 810 7)
国家自然科学基金 ( 3 0 3 40 0 3 0 )资助~~
