Bootsma G P, Dekhuijzen P N, Festen J, Mulder P G, Swinkels L M, van Herwaarden C L
Department of Pulmonary Diseases, University Hospital, Nijmegen, the Netherlands.
Am J Respir Crit Care Med. 1996 Mar;153(3):924-30. doi: 10.1164/ajrccm.153.3.8630574.
Inhaled corticosteroids (ICS) in dosages above 1,000 micrograms/d may influence parameters of bone metabolism. Fluticasone propionate (FP) is a new ICS with a higher clinical potency than beclomethasone dipropionate (BDP) combined with negligible oral bioavailability. The aim of this study was to evaluate the effects of FP and BDP in clinically equipotent dosages on indices of bone metabolism and morning cortisol. FP 750 micrograms/d and BDP 1,500 micrograms/d were compared in a randomized, double-blind, crossover study consisting of two 6-wk treatment periods, each preceded by a 3-wk single-blind placebo period. Twenty-one nonsmoking asthmatic completed the study. FP had the same effect on FEV1 and peak expiratory flow as the double dose of BDP. Both treatments did not change morning cortisol. BDP decreased both osteocalcin and procollagen type 1 carboxyterminal propeptide, indices of bone formation, significantly by 18.5 and 21.9%, respectively. In contrast, FP did not change any variable of bone formation. FP and BDP did not increase type 1 collagen carboxyterminal telopeptide and deoxypyridinoline crosslinks, both markers of bone resorption. In changes in parameters of bone metabolism indicate adverse effects on bone quality in the long term, FP may offer an advantage over BDP.
剂量超过1000微克/天的吸入性糖皮质激素（ICS）可能会影响骨代谢参数。丙酸氟替卡松（FP）是一种新型ICS，其临床效力高于二丙酸倍氯米松（BDP），且口服生物利用度可忽略不计。本研究的目的是评估临床等效剂量的FP和BDP对骨代谢指标和早晨皮质醇的影响。在一项随机、双盲、交叉研究中，比较了750微克/天的FP和1500微克/天的BDP，该研究包括两个6周的治疗期，每个治疗期之前都有一个3周的单盲安慰剂期。21名不吸烟的哮喘患者完成了该研究。FP对第一秒用力呼气容积（FEV1）和呼气峰值流速的作用与双倍剂量的BDP相同。两种治疗均未改变早晨皮质醇水平。BDP使骨钙素和I型前胶原羧基末端前肽（骨形成指标）分别显著降低18.5%和21.9%。相比之下，FP未改变任何骨形成变量。FP和BDP均未增加I型胶原羧基末端肽和脱氧吡啶啉交联物（两者均为骨吸收标志物）。如果骨代谢参数的变化表明长期对骨质量有不良影响，那么FP可能比BDP具有优势。
