哮喘患儿垂体－肾上腺轴功能及去炎松的影响

HYPOTHALAMIC-PITUITARY-ADRENAL-AXIS FUNCTION OF ASTHMATIC CHIL-DREN AND EFFECT OF TRIAMCINOLONEACETONIDE

对５８例哮喘急性发作期患儿与４５例健康儿童，用放射免疫法测定血浆皮质醇、促肾上腺皮质激素（ＡＣＴＨ）。结果，血浆皮质醇、ＡＣＴＨ在哮喘患儿为５３９±３２５ｎｍｏｌ／Ｌ、５．０±１．９ｐｍｏｌ／Ｌ；健康儿童为５１０±２４８ｎｍｏｌ／Ｌ、４．７±１．９ｐｍｏｌ／Ｌ，差异均无显著意义。２２例哮喘急性发作患儿，经去炎松Ａ治疗后，在第７、１４、２１天皮质醇抑制率分别为７６．４％、７３．１％、６９．９％，第２８天恢复，第７、１４天ＡＣＴＨ抑制率分别为２８．３％、３４．０％，第２１天恢复。５８例患儿中，７例急性发作期作ＡＣＴＨ兴奋试验，度质醇升高范围为２２３～６３２ｎｍｏｌ／Ｌ。２２例患儿中，６例用去炎松Ａ肌肉注射后，第８～１４天ＡＣＴＨ兴奋试验，皮质醇升高范围为５～１２７ｎｍｏｌ／Ｌ。结果提示，哮喘急性发作期患儿血浆皮质醇、ＡＣＴＨ浓度，ＡＣＴＨ兴奋试验均正常；去炎松Ａ治疗哮喘时，其垂体－肾上腺轴功能受到抑制，２８天后血浆皮质醇浓度恢复正常；用去炎松Ａ治疗哮喘方法简单，沮应注意它的副作用，谨慎使用。

he plasma cortisol and adrenocorticotrophin(ACTN)were measured by radioimmunoassay in 58asthmatic and 45 control children.The level of plas-ma 539±vs.570±248nmol/L,P>0.05)and ACTH(5.0±1.9vs.4.7±1.9mol/L,P>0.05)were notsignificantly different between the asthmatic and con-trol cases.The inhibitory rate of plasma cortisol in 22asthmatic children treated with triamcinolone acetonidewas 76.4%,73.1% and 69.9% on the 7th, 14th and21th day,respectively,and recovered on the 28th day.The inhibtory rate of ACTH was 28.3% and 34.0%on the 7th and 14th day,respectively,and recoveredon the 21th day.ACTH stimulation test in 7 asthmaticchildren showed that(the cortisol levels increased from223nmol/L to 632nmol/L.ACTN stimulation test in 6cases treated with triamcinolone acetonide showed thaton the 8th～14th days thecortisol levels increased 5～127nmol/L.This study indicated that the plasma corti-sol,ACTH and ACTH stimulation test in asthmaticchildren were normal,hypothalamo-pituitary-adrenal-axis function of asthmatic children treated with triamci-nolone acetonide was suppressed,and the level of plas-ma cortisol recovered 28 days later.