Ibrahim Aghil, Dahlqvist Per, Olsson Tommy, Lundgren David, Werner Mårten, Suhr Ole B, Karling Pontus
Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, SE-90187 Umeå, Sweden.
Therap Adv Gastroenterol. 2017 Nov;10(11):829-836. doi: 10.1177/1756283X17730748. Epub 2017 Sep 21.
Adrenal insufficiency (AI) secondary to treatment with glucocorticoids (GCs) is common in patients with inflammatory bowel disease (IBD), but little is known about the relationship between AI and the clinical course in IBD. The aim of the study was to compare the clinical course in IBD patients with normal adrenal function versus patients with subnormal adrenal function.
A retrospective observational study on 63 patients with IBD who had performed a low-dose short Synacthen test (LDSST) (1 μg) immediately (1-7 days) after a standard course of GCs. A subnormal LDSST was defined as serum cortisol <550 nmol/L. Outcomes were time to next flare and fecal calprotectin levels.
Sixty-three percent ( = 40) of the IBD patients had a subnormal LDSST. Patients who were steroid-free ( = 41) after the LDSST were observed for 3 years. Patients with a peak serum cortisol <400 nmol/L immediately after GC treatment had significantly longer time until the next flare-up of their IBD and tended to use a lower cumulative prednisolone dose during the study period in comparison to the other subgroups. Fecal calprotectin levels were significantly lower in patients with a peak s-cortisol <550 nmol/L versus patients with peak s-cortisol ⩾550 nmol/L (median 336 µg/g (IQR 521) 955 µg/g (IQR 1867); = 0.012).
GC-induced AI is common in patients with IBD and is associated with lower disease activity. This suggests a link between responsiveness to GC treatment and suppression of the hypothalamic-pituitary-adrenal axis in IBD.
糖皮质激素（GC）治疗继发的肾上腺功能不全（AI）在炎症性肠病（IBD）患者中很常见，但关于AI与IBD临床病程之间的关系知之甚少。本研究的目的是比较肾上腺功能正常的IBD患者与肾上腺功能不全的患者的临床病程。
一项回顾性观察研究，对63例IBD患者进行了研究，这些患者在接受标准疗程的GC治疗后立即（1 - 7天）进行了低剂量短程促肾上腺皮质激素试验（LDSST）（1μg）。LDSST结果异常定义为血清皮质醇<550 nmol/L。观察指标为下次病情复发时间和粪便钙卫蛋白水平。
63%（n = 40）的IBD患者LDSST结果异常。对LDSST后停用类固醇的患者（n = 41）进行了3年的观察。与其他亚组相比，GC治疗后即刻血清皮质醇峰值<400 nmol/L的患者直到IBD下次复发的时间明显更长，且在研究期间倾向于使用更低的累积泼尼松龙剂量。血清皮质醇峰值<550 nmol/L的患者粪便钙卫蛋白水平显著低于血清皮质醇峰值⩾550 nmol/L的患者（中位数分别为336 μg/g（IQR 521）和955 μg/g（IQR 1867）；P = 0.012）。
GC诱导的AI在IBD患者中很常见，且与较低的疾病活动度相关。这表明IBD患者对GC治疗的反应性与下丘脑 - 垂体 - 肾上腺轴的抑制之间存在联系。
