Smith David J F, Prabhudev Hemanth, Choudhury Sirazum, Meeran Karim
Department of EndocrinologyImperial College Healthcare NHS Trust, London, UK.
Department of Clinical BiochemistryImperial College Healthcare NHS Trust, London, UK.
Endocr Connect. 2017 Nov;6(8):766-772. doi: 10.1530/EC-17-0257. Epub 2017 Oct 10.
Patients who need glucocorticoid replacement in both primary and secondary adrenal insufficiency (AI) have the choice of either once-daily prednisolone or thrice-daily hydrocortisone. A recent European study found no difference between prednisolone and hydrocortisone users in several markers including glucose, weight, body mass index, systolic and diastolic blood pressure and waist circumference, although an increase in cholesterol and low-density lipoprotein (LDL) was suggested in a subgroup of these patients. The aim of this study was to expand the evidence base for the use of these agents as replacement therapy.
Data from 82 patients on hydrocortisone and 64 patients on prednisolone for AI at Imperial College Healthcare NHS Trust were analysed.
There was no significant difference in total cholesterol, LDL levels or any other risk factors between hydrocortisone and prednisolone patients. Prednisolone was subjectively significantly more convenient than hydrocortisone ( = 0.048).
Prednisolone once daily is more convenient than hydrocortisone thrice daily, and there is no difference in the markers of cardiovascular risk measured. Because prednisolone mimics the circadian rhythm better than other glucocorticoids, it should be considered as an alternative to hydrocortisone for AI.
原发性和继发性肾上腺皮质功能减退（AI）患者在选择糖皮质激素替代治疗时，可选用每日一次的泼尼松龙或每日三次的氢化可的松。最近一项欧洲研究发现，在包括血糖、体重、体重指数、收缩压和舒张压以及腰围等多项指标上，服用泼尼松龙和氢化可的松的患者之间没有差异，不过在这些患者的一个亚组中，胆固醇和低密度脂蛋白（LDL）有所升高。本研究的目的是扩大这些药物作为替代疗法使用的证据基础。
对帝国理工学院医疗保健国民信托基金中82例接受氢化可的松治疗和64例接受泼尼松龙治疗的AI患者的数据进行了分析。
氢化可的松组和泼尼松龙组患者的总胆固醇、LDL水平或任何其他风险因素均无显著差异。泼尼松龙在主观上比氢化可的松明显更方便（P = 0.048）。
每日一次的泼尼松龙比每日三次的氢化可的松更方便，且在测量的心血管风险指标上没有差异。由于泼尼松龙比其他糖皮质激素更能模拟昼夜节律，因此应考虑将其作为AI患者氢化可的松的替代药物。
