糖皮质激素治疗社区获得性肺炎的适应症

IF 2.2 4区医学 Q2 INFECTIOUS DISEASES

Infectious diseases now Pub Date : 2025-07-30 DOI:10.1016/j.idnow.2025.105127

Mathieu Blot , Damien Basille , Aurélien Dinh , François Barbier , Pierre Fillatre

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引用次数: 0

摘要

先前关于社区获得性肺炎（CAP）治疗和管理的指南不支持系统使用皮质类固醇。文献中的数据显示出相互矛盾的结果；虽然一些研究表明严重CAP病例的临床改善，但其他研究报告没有显著的益处。最近的CAPE-COD试验表明，早期氢化可的松治疗（200mg /d）可显著降低死亡率和插管率。因此，2025年法国指南建议将其用于需要重症监护的严重CAP病例（不包括流感、骨髓抑制和吸入性肺炎，试验未考虑这些病例），并在8至14天的过程中逐步缓解。由于对非严重的CAP没有任何益处，在这些病例中不建议使用皮质类固醇治疗。

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Indications for corticosteroids in the treatment of Community-Acquired pneumonia

Preceding guidelines on treatment and management of community-acquired pneumonia (CAP) do not endorse systematic use of corticosteroids. The data in the literature show contradictory results; while some have suggested clinical improvement in cases of severe CAP, others have reported no significant benefit.

The recent CAPE-COD trial demonstrated a marked reduction of mortality and intubation through early hydrocortisone treatment (200 mg/d). Consequently, the 2025 French guidelines recommend its being used in cases of severe CAP requiring critical care (excluding influenza, myelosuppression, and aspiration pneumonia, which are not considered in the trial), with progressive de-escalation over the course of eight to fourteen days. Since no benefit has seen shown for non-severe CAP, corticosteroid therapy is not recommended in these cases.

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