糖皮质激素在结核病治疗中的合理应用专家共识

doi:10.19982/j.issn.1000-6621.20210683

摘要/Abstract

摘要：

糖皮质激素具有抗炎、抗过敏、抗细菌内毒素和免疫抑制等药理作用,能够减轻机体对结核分枝杆菌变态反应所致的免疫损伤。但糖皮质激素在迅速控制病情的同时可以导致菌群失调、消化性溃疡、骨质疏松等不良反应。临床上使用糖皮质激素辅助治疗结核病存在不合理现象,因此,亟需规范糖皮质激素在结核病治疗中的应用。本共识简要介绍了糖皮质激素治疗结核病的优势和基本原则,提出必要时在强力有效抗结核药物治疗的前提下应用糖皮质激素辅助治疗结核性脑膜炎、结核性心包炎、结核性胸膜炎、结核性腹膜炎、急性血行播散性肺结核、干酪性肺炎等的推荐意见,以及应用糖皮质激素的注意事项、不良反应及应对措施;强调糖皮质激素辅助治疗结核病应慎重并严格掌握适应证,权衡利弊,规范使用。

关键词: 糖皮质激素类, 结核, 治疗应用, 总结性报告(主题)

Abstract:

Glucocorticoids have pharmacological effects of anti-inflammatory, anti-allergic, anti-bacterial endotoxin and immunosuppression, and can reduce immune damage caused by an allergic reaction to Mycobacterium tuberculosis.Glucocorticoids can quickly control the disease, but also can lead to adverse reactions such as dysbacteriosis, peptic ulcer, osteoporosis, and so on. There is still unreasonable use of glucocorticoids in the adjuvant treatment of tuberculosis in the clinic. Therefore, it is urgent to standardize the application of glucocorticoids in the treatment of tuberculosis.This consensus briefly introduces the advantages and basic principles of glucocorticoid therapy for tuberculosis, provides a recommendation of glucocorticoids used in the adjuvant treatment of tuberculous meningitis, tuberculous pericarditis, tuberculous pleuritis, tuberculous peritonitis, acute disseminated pulmonary tuberculosis, and caseous pneumonia under the strong and effective anti-tuberculosis treatment when necessary, and forwards the precautions, adverse reactions, and solution for the application of glucocorticoids. It is emphasized that more strict indications, the balance of advantages and disadvantages, rational use of glucocorticoids in the adjuvant treatment of tuberculosis.

Key words: Glucocorticoids, Tuberculosis, Therapeutic uses, Consensus development conferences as topic

中图分类号:

R521
R81

中国人民解放军总医院第八医学中心结核病医学部/全军结核病研究所/全军结核病防治重点实验室/结核病诊疗新技术北京市重点实验室, 《中国防痨杂志》编辑委员会. 糖皮质激素在结核病治疗中的合理应用专家共识[J]. 中国防痨杂志, 2022, 44(1): 28-37. doi: 10.19982/j.issn.1000-6621.20210683

Tuberculosis Prevention and Control Key Laboratory/Beijing Key Laboratory of New Techniques of Tuberculosis Diagnosis and Treatment /Institute for Tuberculosis Research/Department of Tuberculosis of the 8th Medical Center of Chinese PLA General Hospital, Editorial Board of Chinese Journal of Antituberculosis . Expert consensus on the rational use of glucocorticoids in tuberculosis treatment[J]. Chinese Journal of Antituberculosis, 2022, 44(1): 28-37. doi: 10.19982/j.issn.1000-6621.20210683

图/表 2

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表2

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证据	具体描述
质量等级
高	非常确信真实的效应值接近效应估计值
中	对效应估计值有中等程度的信心:真实值有可能接近估计值,但仍存在二者大不相同的可能性
低	对效应估计值的确信程度有限:真实值可能与估计值大不相同
极低	对效应估计值几乎没有信心:真实值很可能与估计值大不相同
推荐强度
强	支持使用某项干预措施的强推荐,干预措施明显利大于弊
弱	支持使用某项干预措施的弱推荐,干预措施可能利大于弊
弱	反对使用某项干预措施的弱推荐,干预措施可能弊大于利或利弊关系不明确
强	反对使用某项干预措施的强推荐,明确显示干预措施弊大于利

类别	药物	对糖皮质激素受体的亲和力比值	水盐代谢比值	糖代谢比值	抗炎作用比值	等效剂量 (mg)	血浆半衰期 (min)	作用持续时间(h)
短效	氢化可的松	1.00	1.0	1.0	1.0	20.00	90	8~12
	可的松	0.01	0.8	0.8	0.8	25.00	30	8~12
中效	泼尼松	0.05	0.8	4.0	3.5	5.00	60	12~36
	泼尼松龙	2.20	0.8	4.0	4.0	5.00	200	12~36
	甲泼尼龙	11.90	0.5	5.0	5.0	4.00	180	12~36
	曲安西龙	1.90	0.0	5.0	5.0	4.00	>200	12~36
长效	地塞米松	7.10	0.0	20.0~30.0	30.0	0.75	100~300	36~54
	倍他米松	5.40	0.0	20.0~30.0	25.0~35.0	0.60	100~300	36~54