吸入性糖皮质激素对哮喘患儿血清1,25-(OH)_2D_3、皮质醇及促肾上腺皮质激素水平的影响

The Effect of Inhaled Glucocorticoids on the Serum Levels of 1,25-(OH)_2D_3, Cortisol and Adrenocorticotropic Hormone in Children with Bronchial Asthma

目的：探讨吸入性糖皮质激素对哮喘患儿血清1,25-（OH）2D3、皮质醇及促肾上腺皮质激素水平的影响。方法：随机选取56例支气管哮喘患儿（其中轻度哮喘患儿30例,中度哮喘患儿26例）,应用吸入性糖皮质激素进行治疗。5岁以下的哮喘患儿给予硫酸沙丁胺醇气雾剂每喷100μg,2喷/次,3次/天,丙酸氟替卡松气雾剂每喷125μg,1喷/次,3次/天,治疗时均加用储雾罐辅助,治疗1~2周,待症状控制后,停用硫酸沙丁胺醇,丙酸氟替卡松减量为2次/天;5岁以上的哮喘患儿使用布地奈德-福莫特罗吸入剂或沙美特罗-替卡松粉吸入剂2次/天,按照病情控制情况逐步减量。分别于治疗前及治疗后4、8、12个月采集静脉血2 m L,采用放射免疫法检测血清1,25-（OH）2D3、皮质醇及促肾上腺皮质激素水平。结果：治疗前及治疗后4、8、12个月患儿血清1,25-（OH）2D3、皮质醇及促肾上腺皮质激素水平均在正常范围内,无明显下降趋势,不同时间点比较差别无统计学意义（P〉0.05）。结论：吸入性糖皮质激素对哮喘患儿骨骼的代谢、下丘脑-垂体-肾上腺轴功能无明显影响,在临床上长期应用吸入性糖皮质激素治疗儿童支气管哮喘是安全有效的。

Objective： To explore the effects of inhaled glucocorticoids on the serum levels of 1,25-（ OH）2D3,cortisol and adrenocorticotropic hormone in children with bronchial asthma. Methods： Randomly selected 56 children with bronchial asthma（ 30 cases with mild asthma,16 cases with moderate asthma） and treated with inhaled glucocorticoids. Asthmatic children under the age of five used salbutamol sulfate aerosol（ 100 μg every one spray,2 sprays every time,three times a day） and fluticasone propionate aerosol（ 125 μg every one spray,2 sprays every time,three times a day）,1 to 2 weeks later,after the symptoms of children were controlled,salbutamol sulfate aerosol was not used,and used fluticasone propionate aerosol 2 times every day. Asthmatic children over the age of five used budesonide and formoterol fumarate powder for inhalation or salmeterol xinafoate and fluticasone propionate powder for inhalation 2 times every day. Venous blood was collected before treatment and 4,8,12 months after treatment respectively. Then we detected the serum levels of 1,25-（ OH）2D3,cortisol and adrenocorticotropic hormone by radioimmunoassay. Results： The serum levels of 1,25-（ OH）2D3,cortisol and adrenocorticotropic hormone was at normal before treatment and after 4,8,12 months treatment. There were no significant differences（ P 〉 0. 05）. Conclusion： Inhaled glucocorticoid has no obvious effect on bone metabolism and the function of hypothalamic pituitary adrenal axis in children with bronchial asthma. In clinical,the long-term use of inhaled corticosteroids in children with bronchial asthma is safe and effective.