Stefanovic Iva M, Verona Eva, Cicak Biserka, Vrsalovic Renata
Department of Pediatrics, University Hospital Sestre Milosrdnice, Vinogradska, Zagreb, Croatia.
Pediatr Int. 2011 Oct;53(5):672-676. doi: 10.1111/j.1442-200X.2011.03334.x.
Eighty percent of asthmatic children develop asthma symptoms by the age of 5 years. Inhaled corticosteroids (ICS), depending on dosage, may cause linear growth reduction and adrenal gland suppression. There are few studies about linear growth of preschool children with asthma. The aim of the present study was to investigate whether there is any effect of fluticasone propionate (FP) on linear growth and adrenal gland function.
Twenty-eight children aged 18-52 months with persistent asthma receiving ICS FP 100-200 µg daily were studied for 1 year. Patients were divided into two groups according to clinical parameters: well (group 1) and poorly controlled (group 2). Height was measured every 3 months and expressed as height standard deviation score (SDS). Cumulative dose of FP expressed in mg was calculated for every patient. Early morning levels of serum adrenocorticotropic hormone (ACTH) and cortisol were assessed at the beginning and at the end of the study.
Patients took FP for an average of 11 months in group 1 and 16 months in group 2, which was not statistically significantly different. At the end of the study height SDS difference was -0.0143 in group 1 and -0.2000 in group 2, which was not statistically significantly different (t= 0.6072, P= 0.5489). There was also no statistically significant difference for average cortisol (P= 0.4381) or ACTH (P= 0.5845) concentration at the end of the study.
FP 100-200 µg daily had no effect on linear growth or on the hypothalamic-pituitary-adrenal gland axis but further follow up is necessary.
80%的哮喘儿童在5岁前会出现哮喘症状。吸入性糖皮质激素（ICS）根据剂量不同，可能会导致线性生长减缓及肾上腺抑制。关于学龄前哮喘儿童线性生长的研究较少。本研究的目的是调查丙酸氟替卡松（FP）对线性生长及肾上腺功能是否有任何影响。
对28名年龄在18 - 52个月、持续哮喘且每日接受100 - 200μg ICS FP治疗的儿童进行了为期1年的研究。根据临床参数将患者分为两组：病情良好组（第1组）和控制不佳组（第2组）。每3个月测量一次身高，并以身高标准差评分（SDS）表示。计算每位患者以毫克表示的FP累积剂量。在研究开始和结束时评估清晨血清促肾上腺皮质激素（ACTH）和皮质醇水平。
第1组患者使用FP的平均时间为11个月，第2组为16个月，差异无统计学意义。研究结束时，第1组身高SDS差异为 - 0.0143，第2组为 - 0.2000，差异无统计学意义（t = 0.6072，P = 0.5489）。研究结束时平均皮质醇（P = 0.4381）或ACTH（P = 0.5845）浓度也无统计学意义上的差异。
每日100 - 200μg的FP对线性生长或下丘脑 - 垂体 - 肾上腺轴无影响，但仍需进一步随访。
