长期吸入糖皮质激素治疗对哮喘儿童肾上腺抑制、生长及骨骼健康的影响。
Effect of long term inhaled corticosteroid therapy on adrenal suppression, growth and bone health in children with asthma.
作者信息
Kwda Anuradha, Gldc Prematilake, Baui Batuwita, Kasr Kannangoda, Us Hewagamage, S Wijeratne, Kantha Lankatilake, Ksh de Silva
机构信息
Lecturer Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
Acting paediatric pulmonologist, University paediatric unit, Lady Ridgeway Hospital for children, Colombo, Sri Lanka.
出版信息
BMC Pediatr. 2019 Nov 5;19(1):411. doi: 10.1186/s12887-019-1760-8.
BACKGROUND
Inhaled corticosteroids (ICS) are the most effective treatment for children with persistent asthma. However adverse effects of ICS on Hypothalamo Pituitary Adrenal (HPA) axis, growth and bone metabolism are a concern. Hence the primary objective of this study was to describe the effects of long term inhaled corticosteroid therapy (ICS) on adrenal function, growth and bone health in children with asthma in comparison to an age and sex matched group of children with asthma who were not on long term ICS. Describing the association between the dose of ICS and duration of therapy on the above parameters were secondary objectives.
METHOD
Seventy children with asthma on ICS and 70 controls were studied. Diagnosis of asthma in selected patients was reviewed according to the criteria laid down by GINA 2018 guidelines. The estimated adult heights were interpreted relative to their Mid Parental Height (MPH) range. Serum calcium, alkaline phosphatase and vitamin D levels were analyzed in both groups and cortisol value at 30 min following a low dose short synacthen test was obtained from the study group. The average daily dose of ICS (Beclamethasone) was categorized as low, medium and high (100-200, 200-400, > 400 μg /day) respectively according to published literature.
RESULTS
Heights of all children were within the MPH range. There was no statistically significant difference in the bone profiles and vitamin D levels between the two groups (Ca: p = 0.554, vitamin D: p = 0.187) but vitamin D levels were insufficient (< 50 nmol/l) in 34% of cases and 41% of controls. Suppressed cortisol levels were seen in 24%. Doses of ICS were low, medium and high in 56, 32 and 12% of children respectively. The association between adrenal suppression with longer duration of therapy (p < 0.01) and with increasing dose of ICS (p < 0.001) were statistically significant.
CONCLUSION
ICS had no impact on the growth and bone profiles but its dose and duration were significantly associated with adrenal suppression.
背景
吸入性糖皮质激素（ICS）是治疗持续性哮喘儿童最有效的方法。然而，ICS对下丘脑-垂体-肾上腺（HPA）轴、生长和骨代谢的不良影响令人担忧。因此，本研究的主要目的是描述长期吸入性糖皮质激素治疗（ICS）与未接受长期ICS治疗的年龄和性别匹配的哮喘儿童相比，对哮喘儿童肾上腺功能、生长和骨骼健康的影响。描述ICS剂量和治疗持续时间与上述参数之间的关联是次要目的。
方法
研究了70名接受ICS治疗的哮喘儿童和70名对照。根据2018年GINA指南规定的标准对选定患者的哮喘诊断进行了复查。相对于其父母平均身高（MPH）范围解释估计的成人身高。分析了两组的血清钙、碱性磷酸酶和维生素D水平，并从研究组获得了低剂量短程促肾上腺皮质激素试验后30分钟的皮质醇值。根据已发表的文献，ICS（倍氯米松）的平均每日剂量分别分为低、中、高（100 - 200、200 - 400、> 400 μg/天）。
结果
所有儿童的身高均在MPH范围内。两组之间的骨指标和维生素D水平无统计学显著差异（钙：p = 0.554，维生素D：p = 0.187），但34%的病例和41%的对照中维生素D水平不足（< 50 nmol/l）。24%的患者出现皮质醇水平受抑制。分别有56%、32%和12%的儿童ICS剂量为低、中、高。肾上腺抑制与治疗持续时间延长（p < 0.01）和ICS剂量增加（p < 0.001）之间的关联具有统计学显著性。
结论
ICS对生长和骨指标无影响，但其剂量和持续时间与肾上腺抑制显著相关。
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