The Effect of Corticosteroid in Conservative Treatment of Patients with Hemoptysis

객혈 환자의 보존적 치료에서 겉질스테로이드의 효과

  • Kwon, Jee Suk (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Yoo, Seung Soo (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kang, Yeh Rim (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Lee, Jeong Woo (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kim, Eun Jin (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Cha, Seung Ick (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Park, Jae Yong (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Jung, Tae Hoon (Department of Internal Medicine, School of Medicine, Kyungpook National University) ;
  • Kim, Chang Ho (Department of Internal Medicine, School of Medicine, Kyungpook National University)
  • 권지숙 (경북대학교 의과대학 내과학교실) ;
  • 유승수 (경북대학교 의과대학 내과학교실) ;
  • 강예림 (경북대학교 의과대학 내과학교실) ;
  • 이정우 (경북대학교 의과대학 내과학교실) ;
  • 김은진 (경북대학교 의과대학 내과학교실) ;
  • 차승익 (경북대학교 의과대학 내과학교실) ;
  • 박재용 (경북대학교 의과대학 내과학교실) ;
  • 정태훈 (경북대학교 의과대학 내과학교실) ;
  • 김창호 (경북대학교 의과대학 내과학교실)
  • Received : 2007.10.25
  • Accepted : 2007.12.12
  • Published : 2007.12.30

Abstract

Background: This study examined the effect of corticosteroids as a short-term treatment for patients with hemoptysis that requires conservative treatment including bed rest, antitussives and antibiotics. Methods: From February 2005 to August 2006, 78 consecutive patients who visited the emergency room because of hemoptysis were enrolled in the study. Patients with hemoptysis due to lung cancer, active pulmonary tuberculosis, and pneumonia were excluded. The 78 patients were divided randomly into a corticosteroid medication group (n=37) and a control group (n=41). The mean control time of hemoptysis, mean in-hospital days, and complications of treatment were investigated prospectively. Results: For the etiology of hemoptysis, inactive pulmonary tuberculosis alone or its associated complications (bronchiectasis and/or aspergilloma) were the most common causes (51%); bronchiectasis alone and bronchitis were the next most common causative diseases (15%, respectively). The patients' characteristics and symptoms in the corticosteroid medication and control groups were similar. The steroid medication group showed a significantly lower mean control time of hemoptysis than the control group ($4.0{\pm}2.7$ days, $6.1{\pm}4.8$ days, respectively) (p=0.022) and had a lower mean number of in-hospital days ($5.8{\pm}3.4$ days, $7.9{\pm}4.8$ days, respectively) (p=0.036). There were no significant complications, such as hospital-acquired pneumonia or gastrointestinal bleeding, related to the use of corticosteroids. Conclusion: The use of corticosteroids as a conservative treatment for hemoptysis due to bronchitis, bronchiectasis, inactive pulmonary tuberculosis and its related complications safely reduces the control time of hemoptysis as well as the number of in-hospital days.

연구배경: 객혈에 대해 안정, 진해제, 및 항생제 등의 보존적 치료를 요하는 환자에서 단기간의 겉질스테로이드 사용이 미치는 영향을 알아보고자 하였다. 방 법: 2005년 2월부터 2006년 8월까지 객혈을 주소로 응급실을 내원한 환자 중 폐암, 활동성 폐결핵 및 폐렴이 의심되는 환자는 제외하고, 그 중 보존적인 치료를 필요로 하는 환자만을 대상으로 하였다. 이들을 무작위로 겉질스테로이드 투여군(37명)과 대조군(41명)으로 나누어 객혈의 평균 중지 시점, 평균 재원기간 및 합병증에 대하여 전향적으로 조사하였다. 결 과: 비활동성 폐결핵 단독 혹은 그에 합병된 질환을 가진 환자가 가장 많았고(51%), 다음으로 기관지확장증 및 기관지염이 각각 15%였으며, 겉질스테로이드 투여군 과 대조군 사이에 환자의 특성과 원인질환의 분포에 따른 차이는 없었다. 겉질스테로이드 투여군이 대조군에 비해 평균 객혈의 평균 중지 시점($4.0{\pm}2.7$일 vs. $6.1{\pm}4.8$일)과 재원기간($5.8{\pm}3.4$일 vs. $7.9{\pm}4.8$일)이 유의하게 짧았다 (각각 p=0.022, p=0.036). 그리고 겉질스테로이드 사용과 관련된 병원성 폐렴이나 위장관 출혈 등 심각한 합병증의 발생은 없었다. 결 론: 기관지염, 기관지확장증, 비활동성 폐결핵 및 그에 합병된 질환에 의한 객혈의 보존적 치료에서 단기간의 겉질스테로이드 사용은 안전하게 객혈 증상과 재원기간을 단축시킬 수 있는 것으로 사료된다.

Keywords

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