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发表于 2009-10-31 21:57:27
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本帖最后由 大人物 于 2009-10-31 22:47 编辑
Headlines like "Death risk linked to steroid use for arthritis" are not comforting, since most of the 2 million rheumatoid arthritis patients in this country have been on steroid pills such as prednisone at one point or another. Yet that's the headline Reuters used last week to announce a new study hinting that RA patients who used prednisone had a higher death rate than those who didn't; the story was also picked up by Scientific American's website and a TV station as far away as New Zealand.
“与使用糖皮质激素治疗关节炎相关的死亡风险”这样的标题让人看了不爽，因为美国2百万RA患者大多数都或多或少地用过诸如强的松等糖皮质激素片剂。然而这却是路透社上周使用的标题，冠以该标题的文章宣称，最新研究提示，使用强的松的RA患者死亡率比不使用的患者高；这一信息也为科学美国人网站所刊登，并且远至新西兰这样的国家其电视台也对此进行了播报。
Yet news headlines like this are way overblown. "We've all known that corticosteroids like prednisone are two-edged swords," says Roland Moskowitz, a rheumatologist at Case Western Reserve University School of Medicine and a leading arthritis researcher. "They do have side effects. But used carefully they are safe, and they are really valuable medications." The drugs damp down inflammation, a hallmark RA symptom.
不过这样的新闻标题未免太夸张了点。“我们都知道，像强的松等糖皮质激素是把双刃剑，”Case Western Reserve大学药学院的风湿病专家、知名关节炎研究者Roland Moskowitz表示，“它们确实有副作用。但是谨慎应用下是安全的，它们是真正有价值的药物。”这类药物能够抑制炎症，而炎症正是典型的RA症状。
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The study, conducted by researchers in Finland and published last month in the Journal of Rheumatology, focused on 600 RA patients, 65 percent of whom had been treated with corticosteroids. Compared with those who didn't get the drugs, corticosteroid patients' risk of death was 14 percent higher after one year and 69 percent higher after 10 years. Causes of death were mostly related to infections.
该研究由芬兰研究人员进行，并于上个月发表在《风湿病学期刊》上，研究对象为600名RA患者，其中有65%的患者都曾接受过糖皮质激素治疗。与未使用过该药物的那些患者相比，用过糖皮质激素的患者的死亡风险在使用1年后高于前者14%，在使用10年后高于前者69%。死亡原因大多与感染有关。
Scary numbers, but steroids may not be the only reason behind them. In their paper, the Finnish researchers caution that other factors could account for the deaths they observed. "It's the sickest patients who get more corticosteroids, and since they were sicker to start with, you'd expect more deaths," says Moskowitz. "Plus they were being treated with many other drugs, so it's impossible to single out the steroids as responsible for the deaths. It could have been other drugs, and it could have been their greater degree of illness."
这些数字可真够惊人的，但糖皮质激素并不是隐藏于其后的唯一原因。在该论文中，芬兰研究人员提醒说，其他因素也可能对他们所观察的死亡作出解释。“使用较多糖皮质激素的往往是最重的患者，由于他们在使用之初即较为严重，因而可以预料到他们中死亡得更多，”Moskowitz表示，“再加上他们还使用许多其他药物治疗，因此不能单独将糖皮质激素挑选出来认作死因。造成死亡的也可能是其他药物，或者可能是他们更重的病情。”
Other studies, in fact, have shown that steroids like prednisone are safe in low doses–less than 7.5 milligrams per day for women and under 10 milligrams for men. "Steroids are very important as 'bridge' therapies" to help patients while they wait for other drugs to kick in, Moskowitz says. "If a patient is seriously flaring with inflammation, you put them on low-dose prednisone for three months until other drugs, such as methotrexate, build up in their bodies enough to have an effect."
实际上，其他研究业已表明，低剂量的强的松等糖皮质激素（女性每日小于7.5毫克，男性每日小于10毫克）是安全的。“糖皮质激素作为‘过渡（bridge，桥）治疗方式’是非常重要的”，其可在患者等待其他药物开始发挥作用时对患者实行帮助，Moskowitz表示，“如果患者炎症严重发作，则可以对他们施用低剂量的强的松3个月，直至甲氨蝶呤等其他药物在其体内积累到一定程度并开始发挥作用为止。”
Steroids can cause side effects like hypertension and osteoporosis, so they are best used for short periods. And people on them need to be carefully watched. But fear of death as a major side effect is premature.
糖皮质激素可引起高血压和骨质疏松等副作用，因此最好短期应用。施用糖皮质激素的人群需要得到仔细观察。不过，担心死亡为其主要副作用未免失之草率。 |
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