Priftis Kostas N, Papadimitriou Anastasios, Nicolaidou Polyxeni, Chrousos George P
Department of Allergy-Pneumonology, Penteli Children's Hospital, Athens, Greece.
Trends Endocrinol Metab. 2008 Jan;19(1):32-8. doi: 10.1016/j.tem.2007.10.005. Epub 2007 Dec 26.
Reduced responsiveness of the hypothalamic-pituitary-adrenal (HPA) axis in patients with various chronic allergic inflammatory disorders and a blunted HPA axis response of poorly controlled asthmatics before long-term treatment with inhaled corticosteroids (ICS) have been reported. It seems that pro- and anti-inflammatory cytokines might be involved in the attenuation of cortisol and adrenocorticotropic hormone (ACTH) responses to stress in these patients. Although long-term ICS treatment might produce mild adrenal suppression in some asthmatic children, improvement of adrenal function has been detected in the majority of cases. We postulate that the anti-inflammatory effects of ICS result both in asthma remission and HPA axis improvement. Adrenal suppression of some asthmatic patients on maintenance ICS seems to be a separate phenomenon, possibly constitutionally or genetically determined.
据报道，患有各种慢性过敏性炎症疾病的患者下丘脑-垂体-肾上腺（HPA）轴反应性降低，且在长期吸入糖皮质激素（ICS）治疗前，控制不佳的哮喘患者HPA轴反应迟钝。这些患者对应激的皮质醇和促肾上腺皮质激素（ACTH）反应减弱可能与促炎和抗炎细胞因子有关。虽然长期ICS治疗可能会在一些哮喘儿童中产生轻度肾上腺抑制，但在大多数病例中已检测到肾上腺功能改善。我们推测ICS的抗炎作用既导致哮喘缓解，也使HPA轴得到改善。一些维持使用ICS的哮喘患者出现肾上腺抑制似乎是一种独立现象，可能由体质或遗传因素决定。
