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HTA:每日小剂量泼尼松龙预防上呼吸道感染儿童激素敏感性肾病综合征复发

2022-05-25 网络 网络

大多数儿童对高剂量泼尼松龙治疗有反应,这种疾病被称为类固醇敏感型肾病综合征(SSNS)。

背景:特发性肾病综合征是儿童最常见的肾小球疾病,在英国的发病率为每100,000名儿童中有2名。然而,在南亚族裔的儿童中,这一比例高达6倍。大多数儿童对高剂量泼尼松龙治疗有反应,这种疾病被称为类固醇敏感型肾病综合征(SSNS)。至少80%的SSNS儿童会复发,这些复发与严重并发症的风险有关,包括败血症、血栓形成、血脂异常和营养不良。用高剂量泼尼松龙治疗复发与主要的短期和长期副作用有关。大约一半的SSNS儿童将开始使用药物进行非皮质类固醇治疗,如左旋咪唑、环磷酰胺、环孢素、他克莫司、霉酚酸酯或利妥昔单抗,以防止复发。先前的研究表明,至少50%的复发源于上呼吸道感染(URTIs)。此外,在患有复发性SSNS的儿童中,一半或更多的URTIs会引发复发。四项试验表明,当诊断出URTI时,每天给予低剂量泼尼松龙5-7天,可降低随后复发的风险。

然而,这些研究规模相对较小(只有36-100名参与者),并非所有的研究都是盲法的,除了一项研究外,所有的研究都只包括那些已经服用隔日泼尼松龙维持治疗的儿童。一项试验包括有频繁复发类固醇敏感型肾病综合征(FRSSNS)病史的儿童,但他们在招募时没有接受维持治疗。两项研究是交叉设计,提出了改变治疗组后反应独立性的问题。一些试验排除了表现出不遵守的参与者。其他人排除了背景治疗改变的患者。所有这些研究都是在南亚或中东进行的,通常包括更广泛的并发感染,包括下呼吸道感染和胃肠炎。感染的流行病学在欧洲是不同的,在那里最常见的并发感染是URTIs。

目的:为了确定生活在温带气候的儿童在接受一系列复发性SSNS维持治疗时,在URTI期间每日服用低剂量泼尼松龙是否有益,需要进行一项大型、安慰剂对照、双盲、随机对照试验。

目的:确定这些发现是否可以在大量英国儿童中验证,这些儿童患有不同背景药物或无背景药物的复发性类固醇敏感型肾病综合征。设计:随机双盲安慰剂对照试验,包括成本-效果分析。

参与者:英国共有122个儿科部门,其中91个招募了患者。根据基于背景治疗的最小化算法,总共365名复发性类固醇敏感型肾病综合征儿童(平均年龄7.6±3.5岁)被随机分组(1 : 1)。80名儿童完成了12个月的随访,没有出现上呼吸道感染。32名儿童退出了试验(14名在发生上呼吸道感染之前),留下了271名儿童的修改后的意向性治疗分析人群(泼尼松龙组和安慰剂组分别为134名和137名儿童)。

干预措施:在上呼吸道感染开始时,儿童接受6天的泼尼松龙(15 mg/m2)或等效剂量的安慰剂。

主要结果指标:主要结果是12个月内任何上呼吸道感染后首次上呼吸道感染相关复发的发生率。次要转归是总体复发率、背景治疗的变化、泼尼松龙的累积剂量、严重不良事件的发生率、皮质类固醇不良反应的发生率、阿申巴赫儿童行为检查表评分和生活质量的变化。按照意向治疗原则进行分析。成本效益分析使用试验数据和决策分析模型来估计1年的质量调整寿命和成本,然后外推16年。

结果:泼尼松龙组有384例上呼吸道感染和82例上呼吸道感染相关复发,安慰剂组有407例上呼吸道感染和82例上呼吸道感染相关复发。在泼尼松龙组和安慰剂组中,经历上呼吸道感染相关复发的患者人数分别为56人(42.7%)和58人(44.3%)(校正风险差-0.024,95%可信区间-0.14至0.09;p = 0.70)。当根据背景治疗分析数据时,没有证据表明治疗效果不同。治疗组之间的次要转归没有显著差异。与标准治疗相比,在上呼吸道感染时每日给予泼尼松龙与质量调整生命年增加(0.9427比0.9424)和平均费用降低(252比254)相关。成本节约是由背景治疗和复发后住院推动的。这一发现对敏感性分析是稳健的。

局限性:没有上呼吸道感染的儿童数量比预期的要多,因此在试验过程中对样本量损耗率进行了相应调整。

图1 试验招募中心地图。

表1试验访问时间表

图2随机处理的季度招募。

表2每个URTI的12个月试验期内URTI时试验药物的总体依从性

表3按治疗组结果/分析的URR数量

表4试验开始时背景治疗的每组试验的上呼吸道感染相关复发

表5各治疗组在任何时间点特定AE的发生率

结论:临床分析表明,在英国儿童中,上呼吸道感染时每天给予6天低剂量泼尼松龙并不能降低激素敏感性肾病综合征复发的风险。然而,与背景治疗和复发相关的成本以及复发对健康相关的生活质量的影响有经济效益。

原文出处:Christian MT,  Webb NJ,  Woolley RL, et al.Daily low-dose prednisolone to prevent relapse of steroid-sensitive nephrotic syndrome in children with an upper respiratory tract infection: PREDNOS2 RCT.Health Technol Assess 2022 Jan;26(3)

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    2023-02-18 ms8729286118158406 来自重庆

    小剂量泼尼松并未能预防复发

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    2023-02-17 pyaili
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    2023-04-17 wangyang7958
  4. [GetPortalCommentsPageByObjectIdResponse(id=2115341, encodeId=5b45211534157, content=小剂量泼尼松并未能预防复发, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=504a1788244, createdName=ms8729286118158406, createdTime=Sat Feb 18 23:58:38 CST 2023, time=2023-02-18, status=1, ipAttribution=重庆), GetPortalCommentsPageByObjectIdResponse(id=2043632, encodeId=3dff20436321e, content=<a href='/topic/show?id=a9c2469e327' target=_blank style='color:#2F92EE;'>#小剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46973, encryptionId=a9c2469e327, topicName=小剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b3e473, createdName=pyaili, createdTime=Fri Feb 17 08:06:51 CST 2023, time=2023-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2034109, encodeId=cb4620341097b, content=<a href='/topic/show?id=89d791e3cb' target=_blank style='color:#2F92EE;'>#HTA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9173, encryptionId=89d791e3cb, topicName=HTA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=267e204, createdName=wangyang7958, createdTime=Mon Apr 17 18:06:51 CST 2023, time=2023-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282586, encodeId=5f87128258663, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388577, encodeId=744213885e7cd, content=<a href='/topic/show?id=7ef25e5346b' target=_blank style='color:#2F92EE;'>#敏感性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57534, encryptionId=7ef25e5346b, topicName=敏感性)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJnkE6UvGFfMS41qV0RicWvVTTeLMicqibeZH5GqO4YhNicyl1Y9jFhylIUBn9ntPYy9jhk5hrfic5cRYw/132, createdBy=5f822500020, createdName=ms5236388012055669, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432322, encodeId=bf4d143232254, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553905, encodeId=2317155390511, content=<a href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=2115341, encodeId=5b45211534157, content=小剂量泼尼松并未能预防复发, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=504a1788244, createdName=ms8729286118158406, createdTime=Sat Feb 18 23:58:38 CST 2023, time=2023-02-18, status=1, ipAttribution=重庆), GetPortalCommentsPageByObjectIdResponse(id=2043632, encodeId=3dff20436321e, content=<a href='/topic/show?id=a9c2469e327' target=_blank style='color:#2F92EE;'>#小剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46973, encryptionId=a9c2469e327, topicName=小剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b3e473, createdName=pyaili, createdTime=Fri Feb 17 08:06:51 CST 2023, time=2023-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2034109, encodeId=cb4620341097b, content=<a href='/topic/show?id=89d791e3cb' target=_blank style='color:#2F92EE;'>#HTA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9173, encryptionId=89d791e3cb, topicName=HTA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=267e204, createdName=wangyang7958, createdTime=Mon Apr 17 18:06:51 CST 2023, time=2023-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282586, encodeId=5f87128258663, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388577, encodeId=744213885e7cd, content=<a href='/topic/show?id=7ef25e5346b' target=_blank style='color:#2F92EE;'>#敏感性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57534, encryptionId=7ef25e5346b, topicName=敏感性)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJnkE6UvGFfMS41qV0RicWvVTTeLMicqibeZH5GqO4YhNicyl1Y9jFhylIUBn9ntPYy9jhk5hrfic5cRYw/132, createdBy=5f822500020, createdName=ms5236388012055669, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432322, encodeId=bf4d143232254, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553905, encodeId=2317155390511, content=<a href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=)]
  6. [GetPortalCommentsPageByObjectIdResponse(id=2115341, encodeId=5b45211534157, content=小剂量泼尼松并未能预防复发, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=504a1788244, createdName=ms8729286118158406, createdTime=Sat Feb 18 23:58:38 CST 2023, time=2023-02-18, status=1, ipAttribution=重庆), GetPortalCommentsPageByObjectIdResponse(id=2043632, encodeId=3dff20436321e, content=<a href='/topic/show?id=a9c2469e327' target=_blank style='color:#2F92EE;'>#小剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46973, encryptionId=a9c2469e327, topicName=小剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b3e473, createdName=pyaili, createdTime=Fri Feb 17 08:06:51 CST 2023, time=2023-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2034109, encodeId=cb4620341097b, content=<a href='/topic/show?id=89d791e3cb' target=_blank style='color:#2F92EE;'>#HTA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9173, encryptionId=89d791e3cb, topicName=HTA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=267e204, createdName=wangyang7958, createdTime=Mon Apr 17 18:06:51 CST 2023, time=2023-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282586, encodeId=5f87128258663, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388577, encodeId=744213885e7cd, content=<a href='/topic/show?id=7ef25e5346b' target=_blank style='color:#2F92EE;'>#敏感性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57534, encryptionId=7ef25e5346b, topicName=敏感性)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJnkE6UvGFfMS41qV0RicWvVTTeLMicqibeZH5GqO4YhNicyl1Y9jFhylIUBn9ntPYy9jhk5hrfic5cRYw/132, createdBy=5f822500020, createdName=ms5236388012055669, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432322, encodeId=bf4d143232254, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553905, encodeId=2317155390511, content=<a href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=)]
  7. [GetPortalCommentsPageByObjectIdResponse(id=2115341, encodeId=5b45211534157, content=小剂量泼尼松并未能预防复发, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=504a1788244, createdName=ms8729286118158406, createdTime=Sat Feb 18 23:58:38 CST 2023, time=2023-02-18, status=1, ipAttribution=重庆), GetPortalCommentsPageByObjectIdResponse(id=2043632, encodeId=3dff20436321e, content=<a href='/topic/show?id=a9c2469e327' target=_blank style='color:#2F92EE;'>#小剂量#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=116, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46973, encryptionId=a9c2469e327, topicName=小剂量)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8b3e473, createdName=pyaili, createdTime=Fri Feb 17 08:06:51 CST 2023, time=2023-02-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2034109, encodeId=cb4620341097b, content=<a href='/topic/show?id=89d791e3cb' target=_blank style='color:#2F92EE;'>#HTA#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=82, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=9173, encryptionId=89d791e3cb, topicName=HTA)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=267e204, createdName=wangyang7958, createdTime=Mon Apr 17 18:06:51 CST 2023, time=2023-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1282586, encodeId=5f87128258663, content=<a href='/topic/show?id=700239e0772' target=_blank style='color:#2F92EE;'>#呼吸道#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=39707, encryptionId=700239e0772, topicName=呼吸道)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=2e94174, createdName=zhmscau, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1388577, encodeId=744213885e7cd, content=<a href='/topic/show?id=7ef25e5346b' target=_blank style='color:#2F92EE;'>#敏感性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=103, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=57534, encryptionId=7ef25e5346b, topicName=敏感性)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJnkE6UvGFfMS41qV0RicWvVTTeLMicqibeZH5GqO4YhNicyl1Y9jFhylIUBn9ntPYy9jhk5hrfic5cRYw/132, createdBy=5f822500020, createdName=ms5236388012055669, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1432322, encodeId=bf4d143232254, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1553905, encodeId=2317155390511, content=<a href='/topic/show?id=adbe650e465' target=_blank style='color:#2F92EE;'>#泼尼松龙#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65074, encryptionId=adbe650e465, topicName=泼尼松龙)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=fb4914457810, createdName=xjy07, createdTime=Tue May 24 11:06:51 CST 2022, time=2022-05-24, status=1, ipAttribution=)]
    2022-05-24 xjy07

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女性患者,82岁,因出现发痒咳嗽和上呼吸道感染症状而就诊。其血氧饱和度正常,也没有其他的系统性疾病。然而,患者有结核病病史,且多年前曾接受手术治疗,具体手术未知。经检查,医生发现患者右肺尖处呼吸声降低,建议胸部摄影检查。胸片显示如下(图1⇓)

Inflamm Bowel Dis:补充维生素D可能对IBD患者的上呼吸道感染有预防作用

我们评估了冬季和早春期间口服维生素D补充剂是否能降低炎症性肠病(IBD)患者的流感和上呼吸道感染的发生率。

Nature子刊:还在喝热水?流感新疗法要来了

流感病毒(influenza)每年影响全球500万人的生活,其中可能有10%的患者因此而死亡。但是目前并没有真正治疗流感的方法,通常的治疗手段是休息和多饮水,等待自身的免疫系统打败病毒的入侵。日前,澳大利亚研究人员率领的研究团队在《Nature Communications》杂志上发表了他们的最新研究,他们的研究可能带来流感疗法方面的重大突破。

Am J Respir Crit Care Med:哮喘患者补充维生素D可否降低感冒风险

背景:改善维生素D的缺乏能减少哮喘发作,哮喘常伴随呼吸道感染(RTIs)和感冒症状。目的:确定维生素D的补充可以减少感冒的发生,以及维生素D缺乏与成年轻-中度哮喘严重程度的关系。方法:评估了从“维生素D的附加治疗提高哮喘病人对糖皮质激素的应答反应的临床实验”中随机纳入的408例成年患者的感冒症状,分别接受安慰剂或维生素D3(100000 IU,追加 4000 IU/日),作为哮喘的附加治疗,为期2

Intern Med:KKT对URTI相关的咽喉痛没有明显缓解作用

Kikyo-to(KKT)是一种由甘草根和板蓝根提取物组成的固定组合。在日本,它是一种传统上用于缓解急性上呼吸道感染(URTI)的咽喉痛的草药。然而,目前尚未有对照研究证实其疗效。我们调查了KKT对急

SAA在儿童上呼吸道感染中的出彩表现

在临床实际应用中,SAA、CRP、WBC计数及分类4项指标联合检测可提高对感染患者病因的诊断准确性,减少误诊率。既能正确指导医师用药,又可观察病情的动态变化。

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