摘要
高剂量吸入皮质类固醇(布地奈德和倍氯米松>或= 800微克。天-1)通常用于治疗哮喘。一些研究人员提出了皮肤效应(挫伤)的证据,提示全身吸收。本研究旨在评估皮肤挫伤的患病率,将皮肤挫伤的发生与肾上腺皮质功能联系起来,并确定皮肤挫伤的危险因素。在哮喘门诊招募100名成年哮喘受试者,服用高剂量(800- 2000微克。天-1)3个月或更长时间的ICS,并从眼科门诊招募100名性别和年龄配对的对照受试者。对哮喘、一般习惯和皮肤损害进行了详细的问卷调查。进行皮肤检查。连续两天评估尿液皮质醇水平。观察血皮质醇水平及对盐酸克特罗辛注射液(60 min试验)的反应。100例成人哮喘患者(女性66例,男性34例),73例使用倍氯米松,27例使用布地奈德。皮肤瘀伤的发生率在问卷调查中为71%(对照组为32%),在直接皮肤检查中为48%(81名受试者中有39名)。 We found a satisfactory association between the response to questionnaire and examination of the skin. Adrenocortical function testing showed that a minority of subjects (14 with at least one abnormal test) had lower urinary or blood cortisol levels. These low cortisol levels occurred in subjects who reported skin bruising. By multiple logistic regression, being a female (odds ratio (OR) = 20; 95% confidence interval (95% CI) = 13-33) and taking ICS for asthma (OR = 12; 95% CI = 8-18) were significantly (t = 5.4) related to the likelihood of developing skin bruising. In addition, among the asthmatic subjects, being older (OR = 1.6; 95% CI = 1.1-2.4/10 yrs interval) (t = 2.3) and being a female (OR = 22; 95% CI = 7-75) (t = 5.0) influenced the occurrence of skin bruising as documented by questionnaire. In asthmatic subjects, taking high doses of ICS is associated with: 1) increased occurrence of skin bruising by comparison with controls, particularly in older subjects; and 2) a generally normal adrenocortical function, although this function is significantly lower in subjects reporting skin bruising.