糖皮质激素治疗腺病毒感染的不良反应及早期防治措施

摘要

Objective To explore adverse reactions of methylprednisolone ( MP) in the treatment of patients affected by ade-novirus and mechanism involved in the osteonecrosis of femoral head ( ONFH) and also to observe effects of early comprehensive pre-vention and treatment .Methods In accordance with the maximum MP daily dosage , 51 confirmed patients were divided into 2 groups:the≥320 mg/d group (n=18) and the ≤320 mg/d group (n=33).Statistical analysis was made on the adverse drug reactions that occurred in the course of treatment .Levels of triaglyceride , total cholesterol , low density lipoprotein cholesterol , blood calcium , serum phosphate, D-Dimer and blood glucose in the patients of both groups were analyzed statistically .For the≥320 mg/d group, such inter-ventions as oral application of calcium atrovopine , warfarin, calcium, calcitriol and phosphonate pills , injection of low molecular hepa-rin sodium, and intravenous dripping of Prostin-VR were implemented for comprehensive prevention and treatment .Levels of the above data were detected and statistical analyses were made accordingly .Results Adverse reactions , such as dyslipidemia , tachycardia , e-lectrolyte disturbance , secondary fungus infection , pathoglycemia and drug withdrawal syndrome were displayed in the patients of the ≥320 mg/d group.When compared with the patients of the ≤320 mg/d group, the levels of total cholesterol , triglycerides, low density lipoprotein cholesterol, serum phosphate and D-Dimer were all increased, but the level of serum calcium was decreased (P <0.05). For the patients in the ≥320 mg/d group, the levels of total cholesterol and D-Dimer were decreased , the level of serum calcium was increased and that of serum phosphate was decreased (P <0.01).The levels of triaglyceride and low density lipoprotein cholesterol were also decreased (P>0.05).Conclusion Methylprednisolone, a double-edged sword in the treatment of adenovirus pneumonia , could bring about serious consequences .Measures should be taken for early prevention and treatment of possible adverse reactions in the course of clinical diagnosis and treatment of the disease , so as to reduce the probability of ONFH .%目的探讨糖皮质激素甲强龙治疗腺病毒感染的不良反应，分析导致股骨头坏死的机制及早期综合防治的疗效。方法收集51例确诊为腺病毒感染患者，根据甲强龙单日最大剂量分组，分为≥320 mg组18例，＜320 mg组33例，对病程中出现的不良反应进行统计学分析。测定2组三酰甘油、总胆固醇、低密度脂蛋白、血钙、血磷、D-二聚体，并进行统计学分析。≥320 mg组根据出现的异常指标，分别给予口服阿托伐他汀钙、皮下注射低分子肝素钠、口服华法林、前列地尔静滴、口服钙剂、骨化三醇和阿仑膦酸钠片等综合防治，治疗前后测定以上指标，进行统计学分析。结果≥320 mg组患者出现血脂异常、心动过速、电解质紊乱、继发真菌感染、血糖异常、撤药综合征等不良反应，与＜320 mg组相比，总胆固醇、三酰甘油、低密度脂蛋白、血磷、D-二聚体升高，血钙下降。≥320 mg组治疗后与治疗前相比，总胆固醇、D-二聚体降低，血钙升高，血磷降低，甘油三酯、低密度脂蛋白降低。结论糖皮质激素治疗腺病毒感染是一把双刃剑，可能导致严重后果，临床诊治过程中要注意早期防治，减少后期出现股骨头坏死机率。