Corticosteroid therapy for treating acute exacerbation of interstitial lung diseases: a systematic review.

While corticosteroids are frequently employed, the optimal regimen and their clinical efficacy remain uncertain.

虽然经常使用皮质类固醇，但最佳的治疗方案及其临床效果仍不确定。

To address this knowledge gap, we undertook a systematic reviewto evaluate the impact of steroid therapy on clinical outcomes in patients experiencing AE-ILD.

为了解决这一知识空白，我们进行了一项系统评价，以评估类固醇治疗对经历急性加重型间质性肺病（AE-ILD）的患者临床结果的影响。

method

Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we systematically searched multiple databases, identifying 12 454 articles.

遵循系统评价和荟萃分析报告的首选报告项目（PRISMA）指南，我们系统地搜索了多个数据库，确定了12 454篇文章。

After removing duplicates and screening titles and abstracts, 447 articles were selected for full-text review.

在去除重复项并筛选标题和摘要后，选出了447篇文章进行全文审查。

Ultimately, nine studies met inclusion criteria, comparing high-dose corticosteroids with low-dose or non-steroidal interventions in treating AE-ILD.

最终，有九项研究符合纳入标准，这些研究比较了高剂量皮质类固醇与低剂量或非类固醇干预措施在治疗急性加重型间质性肺病（AE-ILD）中的效果。

Key outcomes included in-hospital and long-term mortality, as well as AE recurrence.

关键结果包括住院和长期死亡率以及不良事件（AE）的复发。

Results

Analysis of nine studies (total n=18 509) revealed differential treatment effects based on the ILD subtype.

对九项研究（总人数为18,509）的分析揭示了基于间质性肺病（ILD）亚型的治疗效果差异。

In non-idiopathic pulmonary fibrosis (IPF) ILD, high-dose corticosteroid therapy (>1.0 mg/kg prednisolone) demonstrated improved survival (adjusted HR 0.221, 95% CI 0.102 to 0.480, p<0.001) and reduced 90-day mortality.

在非特发性肺纤维化（IPF）间质性肺病中，高剂量类固醇治疗（>1.0 mg/kg 泼尼松）显示出改善生存率（调整后 HR 0.221，95% 置信区间 0.102 至 0.480，p<0.001）并降低90天死亡率。

Early tapering of high-dose corticosteroids (>10% reduction within 2 weeks) reduced in-hospital mortality (adjusted HR 0.37, 95% CI 0.14 to 0.99).

早期减量高剂量类固醇治疗（2周内减少>10%）降低了住院死亡率（调整后 HR 0.37，95% 置信区间 0.14 至 0.99）。

Higher cumulative doses in the first 30 days (5185±2414 mg/month vs 3133±1990 mg/month) were associated with lower recurrence rates (adjusted HR 0.61, 95% CI 0.41 to 0.90, p=0.02).

在最初的30天内累积剂量更高（每月5185±2414毫克对比3133±1990毫克）与较低的复发率相关（调整后风险比0.61，95%置信区间0.41至0.90，p=0.02）。

In IPF patients, however, high-dose therapy showed inconsistent benefits, with some studies reporting increased mortality risk (OR 1.075, 95% CI 1.044 to 1.107, p<0.001).

然而，在特发性肺纤维化（IPF）患者中，高剂量治疗显示出不一致的益处，一些研究报道了增加的死亡风险（比值比1.075，95%置信区间1.044至1.107，p<0.001）。

Conclusions

This review emphasises the potential benefits of individualised treatment approaches for AE-ILD but highlights the need for caution in making definitive recommendations.

本综述强调了针对急性加重型间质性肺病（AE-ILD）采取个体化治疗方案的潜在益处，但同时指出在做出明确建议时需要谨慎。

Although high-dose corticosteroids may show promise, particularly in non-IPF cases, the current evidence is inconsistent, and the lack of robust supporting literature makes it difficult to draw firm conclusions.

尽管高剂量皮质类固醇可能显示出特别在非特发性肺纤维化（non-IPF）病例中的前景，但当前的证据不一致，缺乏有力的支持文献，使得得出明确结论变得困难。

Further research through randomised controlled trials is necessary to refine and optimise therapeutic strategies for AE-ILD.

需要通过随机对照试验进行进一步研究，以完善和优化AE-ILD的治疗策略。