长期使用吸入性糖皮质激素增加慢性阻塞性肺疾病（COPD）患者发生肺炎的风险
2009/03/16
美国Wake Forest 医学院Sonal Singh大夫及同事，通过对18项随机临床研究结果（约17000例慢性阻塞性肺疾病（COPD）患者）的荟萃分析发现，使用吸入性糖皮质激素（单用或与支气管扩张剂联用）24月以上的慢性阻塞性肺疾病（COPD）患者，发生重症肺炎的风险增高60％～70％（P < .001），但肺炎风险的增高并不未增加死亡风险，并且，研究者并未因此推荐COPD患者应停用吸入性糖皮质激素，而是应该权衡该治疗对改善症状及生活质量的治疗作用与增高肺炎发生率间的利弊。
（蔡闯 广州医学院第一附属医院 广州呼吸疾病研究所 510120 摘译）
（Archives of Internal Medicine. 2009 ;169(3):219-229）
Long-term use of inhaled corticosteroids and the risk of pneumonia in chronic obstructive pulmonary disease: a meta-analysis
Singh S, Amin AV, Loke YK.
BACKGROUND: Recent studies have suggested a possible association between pneumonia and the use of inhaled corticosteroids. We aimed to ascertain the risk of pneumonia with long-term inhaled corticosteroid use among patients with chronic obstructive pulmonary disease (COPD).
METHODS: We performed systematic searches with no date restrictions through June 30, 2008, of MEDLINE, EMBASE, the Cochrane Database of Systematic Reviews, regulatory documents, and trial registries. We included randomized controlled trials of any inhaled corticosteroid vs a control treatment for COPD, with at least 24 weeks of follow-up and reporting of pneumonia as an adverse event. Outcomes evaluated included any pneumonia, serious pneumonia, pneumonia-related mortality, and overall mortality.
RESULTS: Eighteen randomized controlled trials (n = 16 996) with 24 to 156 weeks of follow-up were included after a detailed screening of 97 articles. Inhaled corticosteroids were associated with a significantly increased risk of any pneumonia (relative risk [RR], 1.60; 95% confidence interval [CI], 1.33-1.92 [P < .001]; I(2) = 16%) and serious pneumonia (1.71; 1.46-1.99 [P < .001]; I(2) = 0%) but without a significantly increased risk of pneumonia-related mortality (1.27; 0.80-2.03 [P = .31]; I(2) = 0%) or overall mortality (0.96; 0.86-1.08 [P = .51]; I(2) = 0%). Inhaled corticosteroids were associated with a significantly increased risk of serious pneumonia when compared with placebo (RR, 1.81; 95% CI, 1.44-2.29 [P < .001]) or when the combination of inhaled corticosteroids and long-acting beta-agonists was compared with long-acting beta-agonists (1.68; 1.20-2.34 [P = .002]).
CONCLUSION: Among patients with COPD, inhaled corticosteroid use for at least 24 weeks is associated with a significantly increased risk of serious pneumonia, without a significantly increased risk of death.
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