慢性阻塞性气道疾病患者短期泼尼松龙治疗期间的骨转换
Bone turnover during short course prednisolone treatment in patients with chronic obstructive airways disease.
作者信息
Morrison D, Ali N J, Routledge P A, Capewell S
机构信息
Department of Chest Diseases, Llandough Hospital, Penarth, S Glamorgan.
出版信息
Thorax. 1992 Jun;47(6):418-20. doi: 10.1136/thx.47.6.418.
BACKGROUND
Although osteoporosis is a well known side effect of long term prednisolone, the effects of a short course are less clear. Biochemical markers of bone turnover were therefore studied in 10 men with chronic obstructive airways disease who required assessment of "steroid reversibility" (mean age 65 years, mean FEV1 1.2 1).
METHOD
Patients received, single blind, two weeks of placebo, four weeks of prednisolone 20 mg/day, and then two further weeks of placebo.
RESULTS
The mean (SD) fasting urinary hydroxyproline:creatinine ratio, a marker of bone resorption, increased by 65% with prednisolone (from 8.9 (5.7) to 14.7 (8.5) mumol/mmol) and returned to baseline after placebo. Serum alkaline phosphatase, a marker of net bone formation, fell after prednisolone by 28% (from 113 (41) to 81 (30) IU/1). Substantial changes occurred after only two weeks of prednisolone. Serum osteocalcin, calcium, and phosphate concentrations did not change significantly.
CONCLUSIONS
Short courses of prednisolone increased bone resorption and inhibited bone formation after two and four weeks.
背景
尽管骨质疏松是长期使用泼尼松龙众所周知的副作用，但短期使用的影响尚不清楚。因此，对10名需要评估“类固醇可逆性”的慢性阻塞性气道疾病男性患者（平均年龄65岁，平均第一秒用力呼气容积1.2升）进行了骨转换生化标志物的研究。
方法
患者接受单盲治疗，先服用两周安慰剂，接着服用四周泼尼松龙，剂量为每日20毫克，然后再服用两周安慰剂。
结果
作为骨吸收标志物的空腹尿羟脯氨酸与肌酐比值的均值（标准差）在服用泼尼松龙时升高了65%（从8.9（5.7）微摩尔/毫摩尔升至14.7（8.5）微摩尔/毫摩尔），在服用安慰剂后恢复至基线水平。作为净骨形成标志物的血清碱性磷酸酶在服用泼尼松龙后下降了28%（从113（41）国际单位/升降至81（30）国际单位/升）。仅在服用泼尼松龙两周后就出现了显著变化。血清骨钙素、钙和磷酸盐浓度没有明显变化。
结论
短期使用泼尼松龙在两周和四周后增加了骨吸收并抑制了骨形成。
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