糖皮质激素在结核病中的应用价值_黄健.pdf

中南药学 2014 年 1 月 第 12 卷 第 1 期　Central South Pharmacy. January 2014, Vol. 12 No. 1 用药问题讨论 糖皮质激素在结核病中的应用价值 1 2* 黄健 ，李春香 （1. 中南大学湘雅三医院，长沙 410083；2. 长沙市中心医院，长沙 410084） 摘要：糖皮质激素具有许多作用，广泛运用于临床，包括结核病的治疗。但是糖皮质激素在结核病治疗方面 是一把双刃剑，既可辅助治疗结核，减轻症状，改善预后，也可导致结核播散和复发。不过，合理利用糖皮 质激素，严格掌握其适应证，可改善结核病预后，降低其死亡率。根据专家共识和文献资料，肺结核或合并 顽固性咯血、结核性浆膜炎、结核性脑膜炎、变态反应综合征、气管支气管结核、抗结核药所致严重过敏反 应和结核病合并其他需糖皮质激素治疗的疾病均可酌情运用糖皮质激素，获得更好疗效。 关键词：糖皮质激素；结核病；免疫 中图分类号：R969.3　　　　文献标识码：A　　　　文章编号：1672-2981(2014)01-0089-04 doi:10.7539/j.issn.1672-2981.2014.01.022 Value of glucocorticoids in tuberculosis HUANG Jian1, LI Chun-xiang2* (1. Third Xiangya Hospital, Central South University, Changsha 410083; 2. Changsha Centeral Hospital, Changsha 410084) Abstract: Glucocorticoids, which have many functions, are widely used in clinical practice, including the treatment for tuberculosis. However, just as every coin has 2 sides, glucocorticoids can alleviate symptoms and improve progno- sis and be in the adjunctive treatment of tuberculosis, it can also spread mycobacterium tuberculosis and make it recur. If glucocorticoids can be used reasonably within speci? c indications, it will improve prognosis and mortality rates will be lower. According to expert consensus and literature, it is necessary to use glucocorticoids for tuberculosis, includ- ing pulmonary tuberculosis, refractory hemoptysis, tuberculosis serositis, tuberculosis meningitis, allergy syndrome, endobronchial tuberculosis, serious anaphylaxis caused by antituberculosis drugs and tuberculosis with other diseases which need glucocorticoids. Key words: glucocorticoid; tuberculosis; immunity 糖皮质激素是由肾上腺皮质束状带细胞合成和分泌 我国结核病疫情也非常严峻，2010 年就有 499 万成年人 的，包括皮质酮、可的松和氢化可的松等；经过对天然