吸入二丙酸倍氯米松对哮喘儿童的垂体-肾上腺轴功能的影响

Influence of Long-Term Inhalation of Beclomethasone Dipropionate on Pituitary-Adrenal Axis Function in Asthmatic Children

目的 通过检测相关激素水平 ,探讨哮喘患儿吸入二丙酸倍氯米松后对垂体 肾上腺轴功能的影响。方法 将研究对象分成 4组 :正常对照组、哮喘组、短期吸入二丙酸倍氯米松组和长期吸入二丙酸倍氯米松组。应用放射免疫法 ,测定上述 4组儿童的促肾上腺皮质激素 (ACTH)和皮质醇 (cortisol)水平 ,以评估垂体 肾上腺轴功能状态及吸入二丙酸倍氯米松后对其的影响。结果 4组儿童的血清ACTH和cortisol水平之间无明显差别 ;ACTH兴奋实验短期吸入治疗组和长期吸入治疗组与正常对照组和哮喘组比较皮质醇基础值无明显降低 ,与哮喘组比较反应值 (刺激值 -基础值 )则明显降低 (P <0 .0 5 )。结论 吸入治疗一定时间后可使肾上腺皮质功能达到轻度抑制状态 ,但并不随吸入时间延长而产生累积抑制效应。

Objective To evaluate the influence of long term inhalation of beclomethasone dipropionate on pituitary adrenal axis function in asthmatic children. Methods The subjects of the study were randomly divided into four groups: normal controls, asthmatic children not receiving inhalation therapy, asthmatic children receiving short term inhalation of beclomethasone dipropionate, and asthmatic children receiving long term inhalation of beclomethasone dipropionate. The levels of ACTH and cortisol were measured using the radio immunoassay. Results There were no differences in baseline ACTH and cortisol levels between the four groups. However, both the short term [( 328.51 ± 84.62 ) nmol/L] and long term inhalation groups [ 321.79 ± 86.06 ) nmol/L] had lower cortisol responses to ACTH stimulation compared to the asthmatic children not receiving beclomethasone [( 416.16 ± 94.52 ) nmol/L; P< 0.05 ]. Conclusions Inhaled glucocorticoid therapy may slightly inhibit the function of the adrenal gland in asthmatic children, but long term therapy does not result in additional pituitary adrenal axis suppression.