单次醋酸甲泼尼龙硬膜外注射后的下丘脑-垂体-肾上腺皮质轴抑制。

Hypothalamic Pituitary Adrenocortical Axis Suppression following a Single Epidural Injection of Methylprednisolone Acetate.

机构信息

Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Department of Anaesthesia, Post Graduate Institute of Medical Education and Research, Chandigarh.

出版信息

Pain Physician. 2017 Nov;20(7):E991-E1001.

PMID:29149147

Abstract

BACKGROUND

Epidural injections (EIs) are the most commonly performed minimally invasive intervention in managing chronic low back pain (CLBP). There is inconsistency in data to accurately predict the degree of hypothalamic-piuitary-adrenal (HPA) axis suppression in patients receiving exogenous steroid therapy, especially in the form of epidural steroid injections (ESIs).

OBJECTIVE

We aim to quantify the degree and duration of HPA axis suppression after a single ESI of 80 mg methyl prednisolone acetate in patients with CLBP.

STUDY DESIGN

A single open-label prospective study.

SETTING

An operating room of a tertiary care hospital.

METHODS

Patients with CLBP and unilateral radicular pain were included in this study. An ESI of 80 mg of methylprednisolone acetate was administered in each patient. Blood samples for cortisol and adrenocorticotropic hormone (ACTH) were collected before the ESI and on days 7, 14, and 28 after the ESI. The patients' pain levels were graded on the numeric rating scale (NRS) at baseline and on days 7, 14, 28, and 60 after the ESI in the pain clinic.

RESULTS

A total of 30 patients were enrolled in this study. The median with interquartile range (IQR) serum cortisol level at baseline and on days 7, 14, and 28 after intervention were found to be 329.55 (208.49 - 399.48) nmol/L, 72.99 (52.95 - 119.82) nmol/L, 194.45 (73.88 - 292.52) nmol/L, and 302.56 (257.68 - 357.43) nmol/L, respectively. A significant discrease in the serum cortisol levels was observed on days 7 (P < 0.001) and 14 (P < 0.001). Twenty-six (87%), 13 (43%), and 2 (7%) patients had serum cortisol levels below normal (<170 nmol/L) on days 7, 14, and 28, respectively. HPA axis suppression was observed in all of the patients for a median (IQR) period of 14 days (range: 11-17 days).

LIMITATIONS

This study was an unblinded observational study. The effect of a single ESI was studied and the sample collection of day 21 serum cortisol and ACTH were passed over.

CONCLUSIONS

HPA axis function was suppressed after the ESI until day 14 and returned to the normal range by postoperative week 4.

KEY WORDS

Epidural injections, steroids, HPA, suppression, cortisol, ACTH.

摘要

背景

硬膜外注射（EIs）是管理慢性下腰痛（CLBP）最常进行的微创介入治疗。在接受外源性类固醇治疗的患者中，准确预测下丘脑-垂体-肾上腺（HPA）轴抑制程度的数据不一致，尤其是在硬膜外类固醇注射（ESIs）的形式下。

目的

我们旨在量化单次 80mg 醋酸甲泼尼龙硬膜外注射后 CLBP 患者 HPA 轴抑制的程度和持续时间。

研究设计

一项单盲前瞻性研究。

设置

一家三级保健医院的手术室。

方法

本研究纳入了 CLBP 和单侧神经根痛的患者。每位患者均接受 80mg 甲泼尼龙醋酸酯的硬膜外注射。在 ESI 前和 ESI 后第 7、14 和 28 天采集皮质醇和促肾上腺皮质激素（ACTH）的血样。在 ESI 后第 7、14、28 和 60 天，患者在疼痛诊所按数字评分量表（NRS）分级疼痛程度。

结果

本研究共纳入 30 例患者。发现基线和干预后第 7、14 和 28 天的中位血清皮质醇水平（四分位距[IQR]）分别为 329.55（208.49-399.48）nmol/L、72.99（52.95-119.82）nmol/L、194.45（73.88-292.52）nmol/L 和 302.56（257.68-357.43）nmol/L。第 7 天（P<0.001）和第 14 天（P<0.001）观察到血清皮质醇水平显著下降。第 7、14 和 28 天分别有 26（87%）、13（43%）和 2（7%）例患者的血清皮质醇水平低于正常值（<170nmol/L）。HPA 轴抑制在所有患者中中位（IQR）持续 14 天（范围：11-17 天）。