Kannisto S, Korppi M, Remes K, Voutilainen R
Department of Pediatrics, Kuopio University Hospital, Finland.
J Clin Endocrinol Metab. 2000 Feb;85(2):652-7. doi: 10.1210/jcem.85.2.6336.
The aim of the present study was to evaluate the prevalence of adrenal suppression and growth retardation in children using moderate doses of budesonide or fluticasone propionate. Seventy-five asthmatic children were randomly divided into three treatment groups: 30 to the fluticasone propionate (FP), 30 to the budesonide (BUD), and 15 to the cromone (CROM) group. FP doses were 500 microg/day during the first 2 months and 200 microg/day thereafter. The respective BUD doses were 800 and 400 microg/day. A low dose ACTH (0.5 microg/1.73 m2) test was performed before treatment and 2, 4, and 6 months later. The test was considered abnormal if the stimulated serum cortisol concentration was more than 2 SD lower than the pretreatment mean (<330 nmol/L). The low dose ACTH test was abnormal after both the high and low steroid doses in 23% of the children. At the 4 month measurement there were more abnormal tests in the BUD (n = 9) than in the FP (n = 5) group (P < 0.05). At that time also the stimulated concentration of serum cortisol was lower in the BUD than in the CROM group (P < 0.01), whereas the difference between the FP and CROM groups was not significant. During the study year the mean decrease in height SD score was 0.23 in the children treated with BUD, 0.03 in the children treated with FP, and 0.09 in the children treated with CROM; the difference between the BUD and FP groups was significant (P < 0.05). In conclusion, the low dose ACTH test revealed mild adrenal suppression in a quarter of the children using moderate doses of inhaled steroids. A FP dose of 200 microg/day caused less adrenal and growth suppression than did a BUD dose of 400 microg/day.
本研究的目的是评估使用中等剂量布地奈德或丙酸氟替卡松的儿童肾上腺抑制和生长发育迟缓的发生率。75名哮喘儿童被随机分为三个治疗组：30名接受丙酸氟替卡松（FP）治疗，30名接受布地奈德（BUD）治疗，15名接受色甘酸钠（CROM）治疗。FP剂量在前2个月为500微克/天，之后为200微克/天。布地奈德的相应剂量分别为800和400微克/天。在治疗前以及治疗后2、4和6个月进行低剂量促肾上腺皮质激素（ACTH，0.5微克/1.73平方米）试验。如果刺激后的血清皮质醇浓度比治疗前平均值低2个标准差以上（<330纳摩尔/升），则该试验被认为异常。23%的儿童在接受高剂量和低剂量类固醇治疗后，低剂量ACTH试验均异常。在4个月的测量中，布地奈德组（n = 9）异常试验的数量多于丙酸氟替卡松组（n = 5）（P < 0.05）。此时，布地奈德组刺激后的血清皮质醇浓度也低于色甘酸钠组（P < 0.01），而丙酸氟替卡松组和色甘酸钠组之间的差异不显著。在研究年度内，接受布地奈德治疗的儿童身高标准差评分平均下降0.23，接受丙酸氟替卡松治疗的儿童为0.03，接受色甘酸钠治疗的儿童为0.09；布地奈德组和丙酸氟替卡松组之间的差异显著（P < 0.05）。总之，低剂量ACTH试验显示，四分之一使用中等剂量吸入性类固醇的儿童存在轻度肾上腺抑制。每天200微克的丙酸氟替卡松剂量比每天400微克的布地奈德剂量引起的肾上腺抑制和生长抑制更少。
