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目的 探讨SARS治疗中糖皮质激素 (GCS)的疗效及使用方法。方法 收集北京市SARS病历资料 ,对全部病例进行分析诊断 ,建立数据库 ,输入每日临床症状、体格检查及辅助检查。共 12 91例临床诊断病例资料完整 ,作为研究对象 ,分别进行单因素分析及COX多因素回归分析。GCS均换算为甲泼尼龙的剂量 (mg/d)。结果 共 10 84例使用了GCS治疗 ,占总例数的 83 96 % ,未使用GCS者为 2 0 7例。两组年龄 (t =- 1 0 8,P >0 0 5 )、住院距离发病的时间差异均无显著意义(P >0 0 5 )。多因素COX回归分析显示应用GCS组较未用组的病死危险性略高 ,RR为 1 334(95 %可信区间 :0 5 88～ 3 0 2 6 )。其中有基础病使用GCS者RR为 2 0 86 (95 %可信区间 :0 6 94～ 6 2 6 7) ,无基础疾病者为 0 5 36 (95 %可信区间 0 14 6～ 1 970 ) ,P >0 0 5。无基础病患者 ,起始剂量、最大剂量、平均剂量、累积剂量与病死率均呈现“J”型关系 ,过低和过高均增加病死相对危险度 ,中间剂量病死危险略有降低 ,但差异均无显著意义 (P >0 0 5 )。病死相对危险度最低的起始剂量、最大剂量、平均剂量、累积剂量依次为 80～ 16 0mg/d、80～ 16 0mg/d、<80mg/d、10 0 0～ 30 0 0mg。无基础病发病14d以内开始使用GCS者病死RR均小于 1,在 15d后使?
Objective To investigate the efficacy and usage of glucocorticoid (GCS) in the treatment of SARS. Methods The data of SARS cases in Beijing were collected and all the cases were analyzed and diagnosed. The database was established and the daily clinical symptoms, physical examination and auxiliary examinations were entered. A total of 1291 cases of clinical diagnosis of complete data, as the research object, respectively, univariate analysis and COX multivariate regression analysis. GCS is converted to methylprednisolone dose (mg / d). Results A total of 10 84 cases were treated with GCS, accounting for 83-96% of the total number of cases and 270 cases without GCS. There was no significant difference in the duration of hospitalization between the two groups (t = - 1.08, P> 0.05) (P> 0.05). Multivariate Cox regression analysis showed slightly higher risk of dying compared with unused group in the GCS group, with an RR of 1 334 (95% CI: 0 588 to 3226). Among them, patients with underlying diseases who used GCS had a RR of 2086 (95% confidence interval: 694-6276) and 0 5 36 (95% confidence interval 0 14 6-1 970) with no underlying disease , P> 0 0 5. No basis disease, the initial dose, the maximum dose, the average dose, cumulative dose and mortality showed a “J” type relationship, too low and too high increase the relative risk of death, intermediate dose of a slight reduction in the risk of death, but the difference No significant difference (P> 0.05). The starting dose, the maximum dose, the average dose and the cumulative dose with the lowest relative risk of death were 80 ~ 160mg / d, 80 ~ 160mg / d, <80mg / d and 100 ~ 300mg respectively. No underlying disease within 14d onset of GCS mortality RR were less than 1, after 15d?