Salvatoni A, Nosetti L, Broggini M, Nespoli L
Pediatric Department, Faculty of Medicine and Surgery, University of Insubria, Ospedale di Circolo Hospital, Varese, Italy.
Ann Allergy Asthma Immunol. 2000 Sep;85(3):221-6. doi: 10.1016/S1081-1206(10)62470-2.
Prolonged treatment with inhaled steroids is recommended for long-term control of asthma in children; however, it can interfere with growth and body composition.
The aim of this study is to answer the question whether 6 months treatment with inhaled steroids causes body fat accumulation and growth velocity reduction.
Hospital-based, open study of body composition [by dual-energy X-ray absorptiometry (DXA), bioelectrical impedance analysis (BIA) and skinfolds] and growth of 26 asthmatic children, treated for 6 months with inhaled steroids [budesonide (BUD) 400 microg/day (group 1) or fluticasone proprionate (FP) 200 microg/day (group 2)], sodium cromoglycate and beta2-agonist (salbutamol) compared with a control group of 16 asthmatic children treated only with sodium cromoglycate and beta2-agonist.
On average, total and regional fat mass, adjusted for pubertal stage and gender, and growth velocity were similar in all three groups of patients and were not influenced by treatment (% mean change +/- 1 SD of fat mass during treatment in BUD 0.1 +/- 3.0%, FP -1.1 +/- 3%, and control -2.8 +/- 3.5%; ANOVA P > or = .05); however seven patients, two in group 1 (1 preschool child), three in group 2 (2 preschool children) and two in the control group (two prepubertal boys aged 8.5 and 9.5 year), during treatment, showed a growth velocity standard deviation score below the third percentile.
A 6-month treatment with inhaled BUD and FP does not induce body fat accumulation; however, in a few preschool children the treatment was associated with growth velocity below the third percentile. Our results suggest the need for constant monitoring of growth in all asthmatic children on chronic treatment with inhaled steroids. Further studies devoted to the effects of inhaled steroids use in preschool children are needed.
对于儿童哮喘的长期控制，推荐使用吸入性类固醇进行长期治疗；然而，它可能会干扰生长和身体组成。
本研究的目的是回答吸入性类固醇治疗6个月是否会导致体脂堆积和生长速度降低这一问题。
以医院为基础，对26名接受吸入性类固醇（布地奈德400微克/天，第1组；或丙酸氟替卡松200微克/天，第2组）、色甘酸钠和β2受体激动剂（沙丁胺醇）治疗6个月的哮喘儿童进行身体组成（采用双能X线吸收法、生物电阻抗分析法和皮褶厚度测量法）和生长情况的开放性研究，并与16名仅接受色甘酸钠和β2受体激动剂治疗的哮喘儿童对照组进行比较。
平均而言，在根据青春期阶段和性别进行调整后，所有三组患者的全身和局部脂肪量以及生长速度相似，且不受治疗影响（布地奈德组治疗期间脂肪量平均变化百分比±1标准差为0.1±3.0%，丙酸氟替卡松组为-1.1±3%，对照组为-2.8±3.5%；方差分析P≥0.05）；然而，7名患者在治疗期间生长速度标准差评分低于第三百分位数，其中第1组2名（1名学龄前儿童），第2组3名（2名学龄前儿童），对照组2名（2名8.5岁和9.5岁的青春期前男孩）。
吸入布地奈德和丙酸氟替卡松治疗6个月不会引起体脂堆积；然而，少数学龄前儿童的治疗与生长速度低于第三百分位数有关。我们的结果表明，对于所有接受吸入性类固醇长期治疗的哮喘儿童，需要持续监测生长情况。需要进一步开展研究，探讨吸入性类固醇在学龄前儿童中的使用效果。
