Ali N J, Capewell S, Ward M J
Department of Chest Diseases, University of Wales College of Medicine, Llandough Hospital, Penarth.
Thorax. 1991 Mar;46(3):160-4. doi: 10.1136/thx.46.3.160.
This study was performed to determine the effects of high doses of two inhaled corticosteroids, beclomethasone dipropionate and budesonide, on biochemical indices of bone turnover (urinary hydroxyproline:creatine and calcium:creatinine ratios, plasma alkaline phosphatase, and parathyroid hormone). Twelve healthy male doctors, aged 25-36 (mean 30) years, were studied. After a week's run in period eight subjects inhaled beclomethasone dipropionate 2000 micrograms/day and eight inhaled budesonide 1800 micrograms/day for 28 days; this was followed by a week without any treatment. During treatment with beclomethasone dipropionate there was a significant increase in the hydroxyproline:creatinine ratio (a 46% increase at 28 days), and a fall in serum alkaline phosphatase activity (a 7.4% fall at 28 days). There were no significant changes during budesonide treatment. Thus high dose inhaled beclomethasone dipropionate increased biochemical markers of bone resorption and reduced serum alkaline phosphatase, a marker of bone mineralisation. A prospective study in asthmatic patients is indicated to assess the long term effects of high dose inhaled corticosteroids on bone mass.
本研究旨在确定两种吸入性皮质类固醇（二丙酸倍氯米松和布地奈德）的高剂量对骨转换生化指标（尿羟脯氨酸：肌酐和钙：肌酐比值、血浆碱性磷酸酶和甲状旁腺激素）的影响。研究了12名年龄在25 - 36岁（平均30岁）的健康男性医生。在为期一周的导入期后，8名受试者每天吸入2000微克二丙酸倍氯米松，8名受试者每天吸入1800微克布地奈德，持续28天；随后为一周的无治疗期。在使用二丙酸倍氯米松治疗期间，羟脯氨酸：肌酐比值显著增加（28天时增加46%），血清碱性磷酸酶活性下降（28天时下降7.4%）。在布地奈德治疗期间无显著变化。因此，高剂量吸入二丙酸倍氯米松增加了骨吸收的生化标志物，并降低了作为骨矿化标志物的血清碱性磷酸酶。有必要对哮喘患者进行前瞻性研究，以评估高剂量吸入皮质类固醇对骨量的长期影响。
