糖皮质激素治疗哮喘对患者血清骨钙素水平的影响

目的探讨糖皮质激素治疗对哮喘患者骨形成的影响。方法对短期(7 d)吸入二丙酸氯地米松7例(beclometha-sone,BDP 200μg tid,为二丙酸氯地米松组)或口服强的松8例(10~15 mg qd,为强的松组)的哮喘儿童(年龄11~14岁)以及非皮质激素治疗8例的哮喘儿童为对照组),吸入BDP 6例或口服皮质激素5例的成年哮喘患者(年龄20~40岁)以及非皮激素治疗5例哮喘成人患者对照组的血清骨钙素水平(osteocalcin)进行了自身对照研究。结果①在哮喘儿童中,治疗前3组患者骨钙素差异无显著性。吸入BDP(24.99±4.71)μg/L或口服强的松(18.46±4.84)μg/L 1周后,血清骨钙素水平均显著低于对照组〔(30.41±6.79)μg/L,P<0.05和P<0.01〕。吸入BDP前后骨钙素的变化值显著低于口服强的松前后骨钙素的变化值(P<0.01)。②在哮喘成人中,治疗后仅强的松组骨钙素水平〔(5.44±1.39)μg/L〕显著低于非激素组〔(7.05±3.53)μg/L,P<0.01〕。但BDP组治疗前〔(7.30±3.55μg/L)〕与后〔(6.04±2.83)μg/L〕血清骨钙素水平差异有显著性(P<0.05)。此外,还对长期(2个月)吸入小剂量BDP(200μg每日1次或2次)的患者进行了配对对照研究,发现吸入BDP 2个月后患者骨钙素(28.54±5.24)μg/L]显著低于正常对照组〔(33.33±4.24)μg/L,P<0.05〕。结论提示吸入或口服治疗量的皮质激素可使骨钙素下降,有可能导致骨形成的抑制。但它的临床意义还有待进一步研究和探讨。

Effect of Using Glucocorticoid in Treating Asthma on the Level of Serum Osteocalcin

Objective] To investigate the effect of short term glucocorticoid therapy on the bone formation of the patients.Methods] A(7-day) self-matched and randomized trial was carried out.23 children patients with asthma were divide into 3 groups: 7 cases inhaled beclomethasone,8 cases inhaled prednisone,and 8 cases that had received no glucocorticoid treatment were taken as the control group.16 adult patients were divided into 3 groups: 5 cases inhaled beclomethasone,6 cases inhaled glucocorticoid,and 6 cases received no glucocorticoid treatment were taken as the control group.Results] No significant difference was found in the Osteocalcin among the 3 children groups before treatment.After the glucocorticoid treatment,the level of serum Osteocalcin among the cases groups was significantly lower than that in the control group(P<0.01).Significant difference was found in the Osteocalcin among the 3 adult groups before treatment.After treatment,only the level of serum Osteocalcin in the prednisone group was significantly lower than that in the control group(P<0.01).The study also indicated that the level of serum Osteocalcin in the group that inhale BDP for 2 months in small doses was significantly lower than that in the control group(P<0.05). Conclusion] It is indicated that the inhalation of glucocorticoid may lead to the decrease of Osteocalcin and the restrain of bone formation of the patients.