Lane S J, Vaja S, Swaminathan R, Lee T H
Department of Allergy and Respiratory Medicine, Guy's Hospital, London, UK.
Clin Exp Allergy. 1996 Oct;26(10):1197-201.
Although corticosteroid resistant (CR) bronchial asthma is associated with impaired in vitro an din vivo glucocorticoid (GC) responsiveness in mononuclear cell function, it is not known whether this is a cell specific phenomenon or whether these patients are at risk of glucocorticoid side-effects as corticosteroid-sensitive (CS) subjects. In order to address this question we have examined the effects of GCs on biochemical indices of bone turnover in vivo.
Six CS and six CR subjects received prednisolone 40 mg orally at 09.00 daily for 5 days. At 08.30 on day 1 and day 6 a fasting blood was taken for estimation of serum osteocalcin, tartrate resistant acid phosphatase (TRAP) and alkaline phosphatase (ALP; total and bone isoenzyme), and a urine sample taken for estimation of free deoxy-pyridinoline crosslinks. TRAP and ALP were measured by a colorimetric method and osteocalcin and deoxy-pyridinoline crosslinks by ELISA.
Serum osteocalcin (nmol/L) decreased from 1.39 +/- 0.09 (mean +/- SEM) to 1.14 +/- 0.07 (P = 0.023) and from 1.19 +/- 0.05 to 0.96 +/- 0.1 (P = 0.037) in the CS and CR groups respectively. There was no difference between baseline and post-treatment levels in either group. Serum total ALP (units/L) decreased from 178 +/- 7 to 168 +/- 4 (P = 0.02) and from 195 +/- 22 to 175 +/- 16 (P = 0.04) in the CS and CR groups, respectively. There was no difference between baseline and post-treatment levels in either group. There was no significant elevation of deoxy-pyridinoline crosslinks or TRAP and no suppression of bone ALP in either group.
We suggest that CR asthmatics may be equally at risk from the metabolic side-effects of glucocorticoids.
尽管糖皮质激素抵抗（CR）型支气管哮喘与体外及体内单核细胞功能中糖皮质激素（GC）反应受损有关，但尚不清楚这是细胞特异性现象，还是这些患者与糖皮质激素敏感（CS）受试者一样有发生糖皮质激素副作用的风险。为了解决这个问题，我们在体内研究了糖皮质激素对骨转换生化指标的影响。
6名CS受试者和6名CR受试者每天09:00口服泼尼松龙40mg，共5天。在第1天和第6天的08:30采集空腹血样，用于测定血清骨钙素、抗酒石酸酸性磷酸酶（TRAP）和碱性磷酸酶（ALP；总酶和骨同工酶），并采集尿样用于测定游离脱氧吡啶啉交联物。采用比色法测定TRAP和ALP，采用酶联免疫吸附测定法测定骨钙素和脱氧吡啶啉交联物。
CS组和CR组血清骨钙素（nmol/L）分别从1.39±0.09（均值±标准误）降至1.14±0.07（P = 0.023），从1.19±0.05降至0.96±0.1（P = 0.037）。两组治疗前后水平均无差异。CS组和CR组血清总ALP（单位/L）分别从178±7降至168±4（P = 0.02），从195±22降至175±16（P = 0.04）。两组治疗前后水平均无差异。两组中脱氧吡啶啉交联物、TRAP均无显著升高，骨ALP也无抑制。
我们认为CR型哮喘患者可能同样有发生糖皮质激素代谢副作用的风险。
