表面皮质激素吸入治疗儿童哮喘剂量的探讨

Appropriate dosage of inhaled corticosteroid in Chinese asthmatic children

目的探讨我国哮喘儿童吸入皮质激素的疗效及安全性。方法研究５０例间歇发作型及轻度持续发作型哮喘儿童吸入不同剂量（２００～１２００μｇ／ｄ）皮质激素（二丙酸倍氯松，ＢＤＰ）的肺功能、气道高反应性及下丘脑－垂体－肾上腺轴（ＨＰＡＡ）功能的变化。将５０例哮喘患儿随机分为５组（每组１０例），分别吸入安慰剂及ＢＤＰ２００，４００，８００，１２００μｇ／ｄ。结果经过３个月的治疗，各治疗组的第１秒用力呼气容积（ＦＥＶ１），最高呼气流速（ＰＥＦ）及ＰＤ２０－ＦＥＶ１均显著升高，而对照组则无明显变化。治疗前后各组患儿的血浆ＡＣＴＨ及血清皮质醇基础值均无明显变化，血浆皮质醇对ＡＣＴＨ刺激的反应值在对照组及ＢＤＰ２００μｇ组无明显变化，而在ＢＤＰ≥４００μｇ／ｄ时则明显下降。结论２００μｇ／ｄ的ＢＤＰ能有效地改善哮喘儿童的肺功能，降低气道高反应性，但当剂量≥４００μｇ／ｄ时，则可能引起血皮质醇对ＡＣＴＨ刺激的反应性抑制。临床上使用ＢＤＰ吸入疗法治疗间歇发作型及轻度持续发作型儿童哮喘时。

Objective To assess the efficacy and safety of routine recommended doses of inhaled corticosteroid in the management of Chinese asthmatic children.Methods The effects of beclomethason dipropionate(BDP) 200～1200μg/d on lung function,bronchial hyperresponsiveness(BHR) and hypothalamic-pituitar-adrenal axis(HPAA) in 50 Chinese children with asthma(aged 5～14yrs,mean 10yrs) have been investigated.They were randomly divided into five groups(10 for each) with inhaling BDP 200,400,800,1200μg per day and placebo, respectively.Results Before and after 3 months of treatment,FEV 1 PEF and PD 20 -FEV 1 increased significantly in all treated groups but not in control group.There were no significant differences in mean plasma ACTH levels(8am.4pm) before and after treatment in each group.Basal serum cortisol levels(8am) remained unchanged after treatment in all groups.However,serum cortisol response to ACTH was significantly lower after treatment in Group-400μg,Group-800μg and Group-1200μg,as compared with those before treatment.Conclusion BDP used at doses of 200μg/d could improve lung function and BHR.But doses >400μg/d might cause suppression of the response to ACTH in asthmatic children.Since the clinical importance of this suppression is not clear,the recommended dose of the routine inhaled BDP should probably be less than 400μg/d in the long-term management of Chinese asthmatic children.