Byron M A, Jackson J, Ansell B M
J R Soc Med. 1983 Jun;76(6):452-7. doi: 10.1177/014107688307600604.
Linear growth was recorded in 36 children with juvenile chronic arthritis. In 20, the hypothalamic-pituitary-adrenal axis (HPA axis) was assessed by insulin-induced hypoglycaemia, the results of which correlated well with resting cortisol levels. Three groups were identified according to type of corticosteroid regimen administered. Group 1 (6 children), receiving daily corticosteroid therapy, were clearly suppressed and failing to grow. Group 2 (13 children) had received an alternate-day regimen from the initiation of corticosteroid therapy; they were not suppressed and growth was satisfactory in 11. Group 3 (17 children) were receiving alternate-day therapy, but had had daily corticosteroid in the past; they showed no clear pattern of suppression or growth. Factors influencing the recovery of the HPA axis and resumption of growth were assessed. No difference was found in the individual growth of 7 children who commenced alternate-day therapy before the age of 5, compared with matched controls. It is suggested that daily divided doses of corticosteroid should not be used. Ideally, a single morning dose (up to 2 mg/kg) alternate-day regimen should be employed, as this regimen has minimal effects on HPA function and growth, even in young children. For very severe systemic features, it may be necessary to add a small single dose on the alternate day.
对36例青少年慢性关节炎患儿的线性生长情况进行了记录。其中20例通过胰岛素诱发低血糖对下丘脑 - 垂体 - 肾上腺轴（HPA轴）进行了评估，评估结果与静息皮质醇水平密切相关。根据所给予的皮质类固醇治疗方案类型将患儿分为三组。第1组（6例患儿）接受每日皮质类固醇治疗，明显受到抑制且生长停滞。第2组（13例患儿）自开始皮质类固醇治疗起即采用隔日治疗方案；他们未受到抑制，11例生长情况良好。第3组（17例患儿）接受隔日治疗，但过去曾接受每日皮质类固醇治疗；他们未表现出明显的抑制或生长模式。对影响HPA轴恢复和生长恢复的因素进行了评估。与匹配的对照组相比，5岁前开始隔日治疗的7例患儿的个体生长情况未发现差异。建议不应使用每日分次给予皮质类固醇的方法。理想情况下，应采用隔日单次晨起剂量（高达2 mg/kg）的治疗方案，因为该方案对HPA功能和生长的影响最小，即使对幼儿也是如此。对于非常严重的全身症状，可能有必要在隔日时加用小剂量单次给药。
