糖皮质激素硬膜外注射治疗坐骨神经痛：代谢及内分泌后遗症

Glucocorticoid epidural for sciatica: metabolic and endocrine sequelae.

作者信息

Ward A, Watson J, Wood P, Dunne C, Kerr D

机构信息

Bournemouth Diabetes and Endocrine Centre, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK.

出版信息

Rheumatology (Oxford). 2002 Jan;41(1):68-71. doi: 10.1093/rheumatology/41.1.68.

DOI:10.1093/rheumatology/41.1.68

PMID:11792882

Abstract

OBJECTIVE

The study was designed to investigate the effect of epidural administration of glucocorticoid on insulin sensitivity.

METHODS

Ten healthy individuals with sciatica underwent a short insulin tolerance test before and twice following (at 24 h and 1 week) a caudal epidural containing 80 mg triamcinolone. Fasting glucose, insulin and cortisol concentrations were also measured.

RESULTS

The rate of glucose disappearance after insulin administration (k(ITT)) fell from 3.6%/min before the epidural to 1.9%/min 24 h afterwards (P=0.001) and returned to pretreatment values by 1 week. Significantly raised fasting insulin and glucose levels also reflected impaired insulin sensitivity immediately after the epidural. Morning cortisol levels were suppressed after the epidural (49 nmol/l at 24 h and 95 nmol/l at 1 week vs 352 nmol/l at baseline; P<0.01).

CONCLUSIONS

Epidural administration of glucocorticoid results in potent suppression of insulin action and this should be taken into account when patients with diabetes require treatment for sciatica.

摘要

目的

本研究旨在探讨硬膜外给予糖皮质激素对胰岛素敏感性的影响。

方法

10名患有坐骨神经痛的健康个体在接受含80mg曲安奈德的骶管硬膜外注射前、注射后24小时和1周后两次接受短期胰岛素耐量试验。还测量了空腹血糖、胰岛素和皮质醇浓度。

结果

胰岛素给药后葡萄糖消失率（k(ITT)）从硬膜外注射前的3.6%/分钟降至24小时后的1.9%/分钟（P = 0.001），并在1周时恢复到治疗前水平。硬膜外注射后空腹胰岛素和血糖水平显著升高也反映了胰岛素敏感性立即受损。硬膜外注射后早晨皮质醇水平受到抑制（24小时时为49nmol/l，1周时为95nmol/l，而基线时为33nmol/l；P<0.01）。