摘要
目的 探讨我国哮喘儿童吸入糖皮质激素的全身性副作用。方法 将 30例 14岁以下轻度哮喘儿童随机分为安慰剂组 (A组 )、二丙酸倍氯松 (BDP) 2 0 0 μg组 (B组 )、BDP 40 0 μg组 (C组 ) ,每组 10例 ,分别持续吸入安慰剂及BDP 2 0 0、40 0 μg/d 1年 ,观察患儿气道高反应性 (BHR)、身高增长、骨密度 (BMD)、钙磷代谢及下丘脑 垂体 肾上腺轴 (HPAA)功能的影响。结果 B组及C组患儿吸入BDP后PD2 0 FEV1即一秒钟用力呼气容积下降 2 0 %时累积吸入的组胺剂量 [Log(PD2 0 FEV1) ]分别为(2 70± 0 13) μg及 (3 15± 0 18) μg ,与治疗前 [B组 :(2 0 4± 0 47) μg ,C组 :(1 94± 0 46 ) μg]比较 ,差异有显著性 (P均 <0 0 1) ,而B组与C组间比较 ,差异有显著性 (P <0 0 1)。A、B及C组患儿吸入BDP后血骨钙素分别为 (2 9± 12 ) μg/L、(2 2± 6 ) μg/L、(31± 11) μg/L ,血钙为 (2 49± 0 11)mmol/L、(2 39± 0 2 8)mmol/L、(2 2 0± 0 35 )mmol/L ,血磷为 (1 8± 0 6 )mmol/L、(1 7± 0 7)mmol/L、(1 5±0 4)mmol/L ,血碱性磷酸酶为 (4 10± 113)U/L、(337± 99)U/L、(35 1± 12 2 )U/L(P >0 0 5 ) ,桡骨BMD为 (0 40± 0 10 )g/cm2 、(0 42± 0 0 5 )g/cm2 、(0 44± 0 0 2 )g/
Objective To observe the systemic side effects of low dose inhaled Beclomethasone dipropionate (BDP) in children with mild asthma.Methods 30 children with mild asthma were randomly divided into 3 groups to receive treatment with inhaled placebo (group A), BDP 200 μg/d (group B) and BDP 400 μg/d (group C) respectively. Bronchial hyperresponsiveness (BHR), height growth, bone mineral density (BMD), calcium and phosphate metabolism and hypothalamic-pituitary-adrenal axis (HPAA) function were measured.Results Inhaled BDP of 200 μg/d and 400 μg/d reduced BHR in mild asthmatic children and there was no significant difference between two groups [log(PD 20 -FEV 1)]:(2.04±0.47) μg to (2.70±0.13) μg in group A and (1.94±0.46) μg to (3.15±0.18) μg in group B (P<0.01). Serum osteocalcin, calcium, phosphate, alkaline phosphatase, basic cortisol and BMD didn′t change significantly after BDP treatment in three groups (all P>0.05) [In group A, B and C, concentrations serum osteocalcin were (29±12) μg/L, (22±6) μg/L,(31±11) μg/L, serum calcium: (2.49±0.11)mmol/L,(2.39±0.28) mmol/L,(2.20±0.35)mmol/L,serum phosphate: (1.8±0.6) mmol/L,(1.7±0.7) mmol/L,(1.5±0.4) mmol/L, radius BMD:(0.44±0.02) g/cm 2,(0.42±0.05) g/cm 2,(0.40±0.10) g/cm 2, ulna BMD:(0.35±0.04) g/cm 2,(0.36±0.08) g/cm 2,(0.32±0.07) g/cm 2, serum alkaline phosphatase: (410±113) U/L,(337±99 )U/L,(351±122) U/L, serum basic cortisol: (350±86) nmol/L,(407±199) nmol/L,(365±71) nmol/L, lumbar spine (L 4～5 ) BMD:(0.64±0.06) g/cm 2,(0.59±0.08) g/cm 2,(0.62±0.09) g/cm 2 respectively]. Height growth had a trend of reducing after BDP treatment though not reaching statistical difference ( Height standard deviation score (SDS) : 1.1±0.7 to 1.2±0.9 in group A, 1.3±0.7 to 1.3±0.9 in group B and 1.1±0.7 to 1.0±0.7 in group C). Serum cortisol after ACTH stimulation reduced significantly in group C [(621±199) nmol/L to (482±97) nmol/L, P<0.01]. Conclusion The results of this study suggest that 200 μg/d BDP can reduce BHR significantly and has no detected systemic side effects in mild asthmatic children, and 400 μg/d BDP can reduce serum cortisol after ACTH stimulation. The long-term dose of BDP should be controlled to be less than 400 μg/d in children with mild asthma.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2001年第12期740-743,共4页
Chinese Journal of Tuberculosis and Respiratory Diseases
关键词
哮喘
持续吸入疗法
低剂量糖皮质激素
副作用
治疗
儿童
Asthma
Inhaled corticosteroids
Height growth
Bone metabolism
Hypothalamic-pituitary-adrenal axis
