低剂量吸入性糖皮质激素对轻中度哮喘儿童身高的影响

Influence of low dosage of inhaled glucocorticoids on height in children with mild to moderate asthma

目的探讨长期使用吸入性糖皮质激素(inhaled glucocorticoids,ICS)对轻中度哮喘儿童身高的影响。方法 2016年6月至2017年6月,在第四军医大学西京医院哮喘门诊就诊的患儿中,纳入确诊为哮喘的儿童300例。ICS采用丙酸氟替卡松,根据用药情况分为丙酸氟替卡松组、孟鲁司特组、联合用药组(丙酸氟替卡松联合孟鲁司特),每组男性50例、女性50例。同时选取既往无支气管哮喘病史的儿童100例为对照组,男、女各50例。入组时(用药前)及用药3、6、12个月时测量身高。采用单因素方差分析与Tukey's Multiple Comparison检验进行统计分析。结果男、女性患儿的身高趋势相同。在用药3个月及6个月时,孟鲁司特组与对照组的身高生长趋势一致;丙酸氟替卡松组、联合用药组的身高明显落后于孟鲁司特组和对照组,但在用药12个月时无明显差异。男性患儿在用药6个月时,丙酸氟替卡松组、孟鲁司特组、联合用药组、对照组的身高分别为(117.4±13.0)、(119.8±12.6)、(114.4±13.0)、(120.8±12.7)cm;用药12个月时分别为(123.0±12.8)、(123.7±12.7)、(119.0±12.8)、(123.6±12.7)cm,各组间两两比较差异均无统计学意义(P值均﹥0.05)。女性患儿在用药6个月时,丙酸氟替卡松组、孟鲁司特组、联合用药组、对照组的身高分别为(116.0±12.1)、(117.7±12.3)、(114.0±13.2)、(119.6±11.9)cm;用药12个月时分别为(121.7±12.0)、(121.9±12.2)、(119.8±12.7)、(122.9±11.6)cm,各组间两两比较差异均无统计学意义(P值均﹥0.05)。结论轻中度支气管哮喘患儿应用低剂量ICS 12个月,对身高的增长速率无抑制作用。

Objective To explore the influence of low dosage of long-term inhaled glucocorticoids （ICS） on height in children with mild to moderate asthma. Methods From June 2016 to June 2017, 300 cases of children who were diagnosed as mild to moderate asthma in Asthma Clinic of Xijing Hospital, Fourth Military Medical University were included. Fluticasone propionate was adopted as ICS. The subjects were divided into fluticasone propionate group, montelukast group, and drug combination group （fluticasone propionate combined with montelukast）, each of group including 50 females and 50 males. Meanwhile, 100 children （50 females and 50 males） of no history of bronchial asthma were selected as control group. The height was measured before and after taking medicine 3, 6 and 12 months. ANOVA and Tukey＇s Multiple Comparison Test were used for statistically analysis. Results The height trend of males and females were the same. The height growth trend at taking medicine 3 and 6 months between the montelukast group and control group were the same. Meanwhile, height of ftuticasone propionate group and drug combination group obviously fell behind montelukast group and control group, but there was no significant difference at taking medicine 12 months. The height of male children at taking medicine 6 months was respectively （117.4 ± 13.0）, （119.8 ± 12.6）, （114.4 ± 13.0） and （120.8 ± 12.7） cm; that of 12 months was respectively （123.0 ± 12.8）, （123.7 ± 12.7）, （ 119.0±12.8） and （123.6 ± 12.7） cm （all P 〉 0.05 ） . The height of female children at taking medicine 6 months was respectively （116.0 ± 12.1）, （117.7 ± 12.3）, （ 114.0± 13.2） and （119.6± 11.9） cm; that of 12 months was respectively （121.7 ± 12.0）, （121.9 ± 12.2）, （119.8± 12.7） and （122.9 ± 11.6） cm, and there was no significant difference when compared in pairs （ all P 〉 0.05 ） . Conclusion There is no inhibiting effect on the growth rate of children with mild to moderate asthma treated by ICS for 12 months.