男性成人哮喘患者骨质丢失与吸入激素累积用量的关系

Correlation between accumulated doses of inhaled glucocorticosteroids and bone loss in male adult asthmatic patients

目的 探讨哮喘患者吸入糖皮质激素的累积用量与骨质丢失之间的关系。方法 选择64例使用吸入型糖皮质激素治疗的男性成人哮喘患者,按其用量分为A、B两组,A组起始剂量<800μg/d(按布地奈德折算)、B组起始剂量≥800μg/d,测量开始治疗时以及2年后患者腰椎正侧位骨密度和血清骨钙素水平,比较用药前后的变化及其与累积用量间的关系。结果 A组治疗前后腰椎骨密度无明显变化,B组治疗后腰椎骨密度明显下降,累积用量与BMD变化值呈负相关;血清BGP水平在B组治疗后显著降低,而A组变化不明显。结论 大剂量吸入糖皮质激素2年,累积剂量达500 mg以上,即可引起哮喘患者骨质丢失;且认为骨质丢失可能与成骨细胞功能减退有关。

Objective To study the correlation between the accumulated doses of inhaled glucocorticoids and bone loss in adult asthmatic patients. Methods Sixty-four male adult asthmatic patients that received inhaled glucocorticoid therapy were included in this study. The patients were divided into two groups according to the initial inhaled dosage: middle and low dosage group (group A) and high dosage group (group B). The patients' lumbar vertebral bone mineral density (BMD) and serum bone gla protein (BGP) were measured at the initiation and two years after the therapy. The BMD and BGP changes before and after therapy were observed; the correlation between the changes and inhaled accumulated doses was studied. Results In group A, the lumbar vertebral bone mineral density did not change significanty after therapy; in group B, the average dose was 503mg, and the BMD was significantly reduced after two years' treatment. There was negative correlation between the accumulated doses and the reduction of BMD.Conclusion After two years of high dosage inhaled glucocorticoid therapy, there is bone loss in asthmatic patients, possibly owing to the dysfunction of osteoblasts.