Hiemstra Ieteke, Heijsman Sigrid M, Koers Nicoline F, Bocca Gianni, van der Veen Betty S, Veeger Nic J G M, Kamps Arvid W A
J Pediatr Endocrinol Metab. 2015 Mar;28(3-4):359-65. doi: 10.1515/jpem-2014-0061.
The clinical relevance of lower basal cortisol levels in children with asthma is unclear. We compared the salivary cortisol response after a standardized exercise test in children with asthma versus the salivary cortisol response in healthy children.
Nineteen prepubertal children with asthma and 20 prepubertal healthy children performed a standardized exercise test twice. Salivary cortisol levels were determined before exercise and immediately and 15 min after exercise. Morning salivary cortisol levels were determined from saliva collected at home.
Salivary cortisol levels increased in 84.2% of the healthy children compared to 35.0% in children with asthma after the 20-m shuttle-run test. Median increase in salivary cortisol levels was 200.3% [95% confidence interval (CI), 141.8-346.1] in healthy children compared to 89.8% (95% CI, 56.9-181.6) in children with asthma. The response was not related to the morning salivary cortisol level or maintenance dose of inhaled corticosteroids. The mean time to exhaustion of both shuttle-run tests was significantly shorter in children with asthma (mean difference 1.4 min; 95% CI, 0.7-2.3). None of the children had to stop because of dyspnea.
Our study demonstrates that children with asthma using a maintenance dose of inhaled corticosteroids (ICS) have an attenuated salivary cortisol response compared with healthy children.
哮喘患儿基础皮质醇水平较低的临床相关性尚不清楚。我们比较了哮喘患儿与健康儿童在标准化运动试验后的唾液皮质醇反应。
19名青春期前哮喘患儿和20名青春期前健康儿童进行了两次标准化运动试验。在运动前、运动后即刻和运动后15分钟测定唾液皮质醇水平。通过在家收集的唾液测定早晨唾液皮质醇水平。
在20米往返跑试验后，84.2%的健康儿童唾液皮质醇水平升高，而哮喘患儿中这一比例为35.0%。健康儿童唾液皮质醇水平的中位数升高为200.3%[95%置信区间（CI），141.8 - 346.1]，而哮喘患儿为89.8%（95%CI，56.9 - 181.6）。该反应与早晨唾液皮质醇水平或吸入性糖皮质激素的维持剂量无关。哮喘患儿两次往返跑试验的平均疲劳时间显著缩短（平均差异1.4分钟；95%CI，0.7 - 2.3）。没有儿童因呼吸困难而不得不停止试验。
我们的研究表明，与健康儿童相比，使用维持剂量吸入性糖皮质激素（ICS）的哮喘患儿唾液皮质醇反应减弱。
