Choi Hyon K, Seeger John D
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Arthritis Rheum. 2005 Aug 15;53(4):528-35. doi: 10.1002/art.21329.
It has been generally perceived that glucocorticoids adversely affect serum lipid levels, although results of prospective studies have suggested the contrary. In this study, we sought to examine the relationship between glucocorticoid use and lipid profiles in a nationally representative sample of subjects.
Using data from 15,004 participants ages 20 years and older in The Third National Health and Nutrition Examination Survey (1988-1994), we examined the relationship between glucocorticoid use and serum lipid profiles. Glucocorticoid use was determined from the household interview regarding prescription medication use. We used multivariate linear regression to adjust for age, sex, race or ethnicity, education, smoking status, body mass index, physical activity, alcohol consumption, energy fraction from protein and carbohydrates, and total energy intake.
Glucocorticoid use was associated with a higher serum high-density lipoprotein (HDL) cholesterol level and a lower ratio of total cholesterol-to-HDL cholesterol among subjects ages 60 years or older (multivariate difference 9.0 mg/dl [95% confidence interval (95% CI) 3.9, 14.1] and -0.6 mg/dl [95% CI -0.9, -0.3], respectively) but not among those younger than age 60 years (multivariate difference -1.5 mg/dl [95% CI -5.4, 2.5] and 0.1 mg/dl [95% CI -0.3, 0.5], respectively). Correspondingly, glucocorticoid use was associated with a higher serum apolipoprotein A-I (Apo A-I) level and a lower Apo A-I:Apo B ratio (multivariate difference 12.1 mg/dl [95% CI 2.9, 21.3] and 0.16 mg/dl [95% CI 0.03, 0.29], respectively) only among subjects ages 60 years or older. Inhalation/intranasal glucocorticoid use was also associated with a higher serum HDL cholesterol level (multivariate difference 4.9 mg/dl [95% CI 0.3, 9.5]) only among subjects ages 60 years or older.
Our results suggest that glucocorticoid use is not associated with an adverse lipid profile in the US population and may be associated with a favorable lipid profile among persons ages 60 years or older, in concordance with previous prospective studies.
尽管前瞻性研究结果显示相反情况，但人们普遍认为糖皮质激素会对血清脂质水平产生不利影响。在本研究中，我们试图在全国代表性的受试者样本中检验糖皮质激素使用与血脂谱之间的关系。
利用第三次全国健康和营养检查调查（1988 - 1994年）中15004名20岁及以上参与者的数据，我们检验了糖皮质激素使用与血清血脂谱之间的关系。糖皮质激素的使用是通过关于处方药使用的家庭访谈确定的。我们使用多元线性回归来调整年龄、性别、种族或民族、教育程度、吸烟状况、体重指数、身体活动、饮酒量、蛋白质和碳水化合物的能量占比以及总能量摄入。
在60岁及以上的受试者中，使用糖皮质激素与较高的血清高密度脂蛋白（HDL）胆固醇水平以及较低的总胆固醇与HDL胆固醇比值相关（多元差异分别为9.0毫克/分升[95%置信区间（95%CI）3.9，14.1]和 - 0.6毫克/分升[95%CI - 0.9， - 0.3]），但在60岁以下的受试者中则不然（多元差异分别为 - 1.5毫克/分升[95%CI - 5.4，2.5]和0.1毫克/分升[95%CI - 0.3，0.5]）。相应地，仅在60岁及以上的受试者中，使用糖皮质激素与较高的血清载脂蛋白A - I（Apo A - I）水平以及较低的Apo A - I:Apo B比值相关（多元差异分别为12.1毫克/分升[95%CI 2.9，21.3]和0.16毫克/分升[95%CI 0.03，0.29]）。仅在60岁及以上的受试者中，吸入/鼻内使用糖皮质激素也与较高的血清HDL胆固醇水平相关（多元差异为4.9毫克/分升[95%CI 0.3，9.5]）。
我们的结果表明，在美国人群中，使用糖皮质激素与不良血脂谱无关，并且与60岁及以上人群的良好血脂谱可能相关，这与先前的前瞻性研究一致。
