Flotte T R, Loughlin G M
Department of Pediatrics, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Pediatr Pulmonol. 1991;10(3):178-82. doi: 10.1002/ppul.1950100308.
In nine children with steroid-dependent asthma, ranging in age from 2 and 11/12 to 14 and 4/12 years, troleandomycin (TAO) was administered at a dose of 250 mg po QD or BID, along with oral methylprednisolone. Both medications were then rapidly changed to a QOD schedule. Baseline daily steroid dosage requirements decreased from 15.3 +/- 9.1 mg methylprednisolone to 1.4 +/- 0.7 mg (P less than 0.01, paired t-test), and the number of steroid bursts (1-2 mg/kg/day) per year decreased from 12.2 +/- 4.8 to 4.1 +/- 2.0 (P less than 0.01, paired t-test). There was also a significant decrease in the number of hospitalizations per year from 3.4 +/- 4.6 to 0.6 +/- 0.7 (P less than 0.05, paired t-test). The incidence of steroid side effects increased, despite the decrease in the amount of steroid required. Specifically, the prevalence of cataracts increased from 11% to 33% (chi 2 = 4.5, P = 0.15) and the prevalence of hypercholesterolemia increased from 22% to 78% (chi 2 = 16.67, P less than 0.001). There was no elevation of serum transaminases in any of our patients on TAO. Although TAO appears to be efficacious, caution is warranted when TAO is considered for use in younger children with steroid-dependent asthma.
对9名年龄在2岁11个月至14岁4个月之间的激素依赖型哮喘患儿，口服醋竹桃霉素（TAO），剂量为每日250毫克，每日1次或每日2次，同时口服甲基强的松龙。随后两种药物均迅速改为隔日给药方案。基线时每日所需激素剂量从15.3±9.1毫克甲基强的松龙降至1.4±0.7毫克（配对t检验，P<0.01），每年激素冲击剂量（1-2毫克/千克/天）从12.2±4.8次降至4.1±2.0次（配对t检验，P<0.01）。每年住院次数也显著减少，从3.4±4.6次降至0.6±0.7次（配对t检验，P<0.05）。尽管所需激素量减少，但激素副作用的发生率增加。具体而言，白内障患病率从11%升至33%（χ2=4.5，P=0.15），高胆固醇血症患病率从22%升至78%（χ2=16.67，P<0.001）。接受TAO治疗的患者血清转氨酶均未升高。虽然TAO似乎有效，但在考虑将TAO用于年龄较小的激素依赖型哮喘患儿时仍需谨慎。
