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目的:确定皮质类固醇辅助治疗肺结核的安全性与疗效方法:系统综述了1959-1999年发表的11篇关于泼尼松、泼尼松龙及/或促肾上腺皮质激素(ACTH)与标准抗结核化学治疗结合使用的随机比较性研究的论著,共包括对1814例肺结核病人的疗效分析,多数病例为中、重度肺结核并有空洞形成。分析内容包括:退热、体重增加、血清白蛋白、血沉恢复时间、住院期限、痰菌阴转率及速度、肺部浸润及空洞性病变的好转,以判定临床学、微生物学以及放射学疗效。结果:几乎所有研究均表明皮质类固醇治疗均具有 显著疗效,使用皮质类固醇组肺部浸润性病变吸收较快并有一定程度的空洞闭合,这种效果在开始治疗的4个月内尤为突出,并可延至1年。使用皮质类固醇对痰菌阴转率及阴转速度无作用,也未发现与皮质类固醇有关的细菌学复发副反应。结论:对活动性肺结核病人使用皮质类固醇(全身用药)可产生安全明显的早期及远期的临床及放射学疗效。
OBJECTIVE: To determine the safety and efficacy of corticosteroid-assisted adjuvant treatment of tuberculosis. METHODS: A systematic review of 11 articles published between 1959 and 1999 on the relationship between prednisone, prednisolone and / or adrenocorticotropic hormone (ACTH) The randomized comparative study of treatment combined with the treatment of a total of 1814 cases of tuberculosis, including the efficacy analysis, most cases of moderate and severe pulmonary tuberculosis and empty cavity formation. Analyzes included improvement in fever, weight gain, serum albumin, recovery times, length of hospital stay, sputum negative conversion rate and speed, pulmonary infiltrates and cavitary lesions to determine clinical, microbiological, and radiological effects . RESULTS: Almost all studies showed a significant effect of corticosteroid treatment. The use of corticosteroids in the lung infiltrated lesions absorbed more quickly and had a degree of void closure, especially in the first 4 months of treatment Can be extended to 1 year. Use of corticosteroids on sputum negative conversion rate and negative speed no effect, but also did not find corticosteroid-related bacteriological relapse side effects. CONCLUSIONS: The use of corticosteroids (systemic) in patients with active pulmonary tuberculosis produces safe and significant early and long-term clinical and radiological effects.