三种糖皮质激素短期应用对婴幼儿成骨细胞功能的影响

Effect in osteoblasts of infants and toddlers by short-term therapy of three kinds of glucocorticoids

【目的】比较三种糖皮质激素,氢化可的松、甲基强的松龙、地塞米松短期应用对婴幼儿成骨细胞功能的影响。【方法】毛细支气管炎住院治疗的患儿30例,分为氢化可的松组、甲基强的松龙组和地塞米松组。分别给予氢化可的松琥珀酸钠10mg/(kg.d)、甲基强的松龙3～5mg/(kg.d)、地塞米松0.25～0.5mg/(kg.d),均静脉注射,连用5d。于用药前、用药5d结束后采集血,检测骨碱性磷酸酶和总碱性磷酸酶。【结果】1)氢化可的松组、地塞米松组治疗前后血清骨碱性磷酸酶、总碱性磷酸酶水平差异均无统计学意义(t=0.292,P>0.05)。2)甲基强的松龙组治疗前后血清骨碱性磷酸酶水平分别为(82.15±25.86)和(57.27±17.53)U/L,差异有统计学意义(t=3.947,P<0.01);血清总碱性磷酸酶水平分别为(149.71±22.22)和(117.00±24.93)U/L,差异有统计学意义(t=3.111,P<0.05)。3)血清骨碱性磷酸酶和总碱性磷酸酶水平呈高度正相关关系(R=0.703,P<0.01)。【结论】短期应用常规剂量甲基强的松龙即对儿童成骨细胞功能产生抑制作用。血清总碱性磷酸酶可以替代骨碱性磷酸酶反映儿童成骨细胞功能变化情况。在保证同样临床效应前提下,相对于甲基强的松龙和地塞米松,以使用氢化可的松为宜。

【Objective】 To compare the influences in osteoblasts of infants and toddlers by short-term therapy of the three kinds of glucocorticoids（hydrocortisone,methylprednisolone and dexamethasone）.【Methods 】 Thirty children suffered from bronchiolitis were divided into three groups by different kinds of glucocorticoids：the hydrocortisone group,the dosage was 10 mg/（kg·d）,the methylprednisolone group,the dosage was 3~5 mg/（kg·d） and the dexamethasone group,the dosage was 0.25~0.5 mg/（kg·d）.The courses of treatment were all 5 days.The serum concentrations of bone alkaline phosphatase（BAP）and total alkaline phosphatase（TAP） were measured.【Results】 1）The serum levels of BAP and TAP in hydrocortisone group and dexamethasone group before and after the treatment were not different significantly（t=0.292,P0.05）.2）The serum levels of BAP in methylprednisolone group before and after the treatment were（82.15±25.86）U/L and（57.27±17.53）U/L,respectively.There was significant difference（t=3.947,P0.01）.The serum levels of TAP in methylprednisolone group before and after the treatment were（149.71±22.22） U/L and（117.00±24.93）U/L,respectively.There was significant difference（t=3.111,P0.05）.3）There was positive correlation both the serum BAP and TAP（R=0.703,P0.01）.【Conclusions】 The therapy of short-term routine dosage of methylprednisolone could inhibit the function of osteoblasts in infants and toddlers.The serum TAP may replace BAP to monitoring the function of osteoblasts in period of the therapy of glucocorticoids.Under the same clinical effects,hydrocortisone is recommended vis-a-vis methylprednisolone and dexamethasone.