Wilson A M, McFarlane L C, Lipworth B J
Department of Clinical Pharmacology, Ninewells Hospital and Medical School, University of Dundee, Scotland, UK.
J Allergy Clin Immunol. 1998 Apr;101(4 Pt 1):470-4. doi: 10.1016/S0091-6749(98)70354-9.
Intranasal corticosteroids are regarded as the first-line treatment for allergic rhinitis, but few studies have directly compared their systemic effects.
We sought to compare the hypothalamic-pituitary-adrenal (HPA)-axis suppression with three intranasal corticosteroids in terms of basal and dynamic adrenocortical activity.
Sixteen healthy volunteers (mean age, 30.7 years) were studied in a single-blind, randomized, four-way crossover study comparing placebo with 200 microg/day fluticasone propionate (FP), 220 microg/day triamcinolone acetonide (TAA), and 336 microg/day beclomethasone dipropionate (BDP). After 4 days of treatment, an overnight urine collection was taken for cortisol and creatinine excretion starting at 10 PM (14 hours after the fourth dose), and blood was taken for serum cortisol at 8 AM (24 hours after the fourth dose) and after stimulation with adrenocorticotrophic hormone (ACTH) (0.5 microg).
For overnight urinary cortisol excretion compared with placebo (20.8 nmol), there was a significant (p < 0.05) degree of suppression with FP (11.8 nmol) but not with TAA (16.0 nmol) or BDP (16.5 nmol). In terms of fold difference (95% CI for difference) from placebo, this amounted to 1.75-fold (1.01 to 3.03) for FP (43% suppression), 1.30-fold (0.75 to 2.25) for TAA (23% suppression), and 1.26-fold (0.73 to 2.18) for BDP (21% suppression). There was also a trend towards suppression of overnight urinary cortisol/creatinine excretion, but this was not statistically significant (placebo, 5.2 nmol/mmol; TAA, 5.0 nmol/mmol; BDP, 4.3 nmol/mmol; and FP, 4.3 nmol/mmol). Values for serum cortisol before and after ACTH stimulation showed no significant suppression.
Suppression of overnight urinary cortisol occurred with intranasal FP (43%), TAA (23%), and BDP (21%), although this was only statistically significant with FP. None of the drugs were associated with blunting of the response to ACTH stimulation. Further studies are indicated to establish whether the systemic effects of inhaled and intranasal corticosteroids are additive.
鼻内用皮质类固醇被视为过敏性鼻炎的一线治疗药物，但很少有研究直接比较它们的全身效应。
我们试图比较三种鼻内用皮质类固醇在下丘脑-垂体-肾上腺（HPA）轴抑制方面的基础和动态肾上腺皮质活性。
16名健康志愿者（平均年龄30.7岁）参与了一项单盲、随机、四交叉研究，比较安慰剂与每日200微克丙酸氟替卡松（FP）、每日220微克曲安奈德（TAA）和每日336微克二丙酸倍氯米松（BDP）。治疗4天后，从晚上10点（第四剂后14小时）开始进行过夜尿液收集以检测皮质醇和肌酐排泄，在上午8点（第四剂后24小时）以及用促肾上腺皮质激素（ACTH）（0.5微克）刺激后采集血液检测血清皮质醇。
与安慰剂（20.8纳摩尔）相比，过夜尿皮质醇排泄量，FP（11.8纳摩尔）有显著（p < 0.05）程度的抑制，而TAA（16.0纳摩尔）和BDP（16.5纳摩尔）则无。就与安慰剂的倍数差异（差异的95%置信区间）而言，FP为1.75倍（1.01至3.03）（抑制43%），TAA为1.30倍（0.75至2.25）（抑制23%），BDP为1.26倍（0.73至2.18）（抑制21%）。过夜尿皮质醇/肌酐排泄也有抑制趋势，但无统计学意义（安慰剂，5.2纳摩尔/毫摩尔；TAA，5.0纳摩尔/毫摩尔；BDP，4.3纳摩尔/毫摩尔；FP，4.3纳摩尔/毫摩尔）。ACTH刺激前后的血清皮质醇值无显著抑制。
鼻内用FP（43%）、TAA（23%）和BDP（21%）均出现过夜尿皮质醇抑制，不过仅FP具有统计学意义。这些药物均未导致对ACTH刺激反应减弱。需要进一步研究以确定吸入和鼻内用皮质类固醇的全身效应是否具有叠加性。
