摘要
横断面研究表明,哮喘患者接受大剂量吸入糖皮质激素和间歇疗程口服糖皮质激素可减少骨量。这项为期2年的前瞻性研究旨在评估接受高剂量吸入糖皮质激素患者的骨密度变化。患者(n = 33)(男性18-50岁,女性18-40岁)吸入皮质激素1,000-2,000微克x天(-1),随机采用双盲方式选择丙酸氟替卡松1,000微克x天(-1)或二丙酸倍氯米松2,000微克x天(-1)。同时,研究了3个相同年龄范围的开放对照组:哮喘患者(n = 8)接受低剂量吸入糖皮质激素(<或=400微克x天(-1))(A组);慢性、严重哮喘患者(n = 8)口服皮质类固醇(>或=10 mg x天(-1)(B组);(C组)脊柱骨密度测量扫描(定量计算机断层扫描(QCT);分别在基线和治疗6、12和24个月后进行脊柱、股骨颈双x线吸收仪和前臂单光子吸收仪。每3个月采集血清骨钙素、骨碱性磷酸酶、1型胶原前羧基端前肽、脱氧吡啶啉、1型胶原c端肽等生化骨标志物。FP 15例(平均年龄36岁,男性6例),BDP 9例(平均年龄33岁,男性5例);完成了研究。 At 0 months, mean bone mineral density (BMD) was lower in patients receiving inhaled corticosteroids (both low dose and high dose) than in normal volunteers. In the FP-treated group, mean vertebral trabecular BMD quantitative computed tomography remained stable with no evidence of decline, whereas there was some decline in the BDP-treated group. The treatment difference between FP and BDP was statistically significant in favour of FP for quantitative computed tomography measurements after 12 months (p = 0.006) and 24 months (p = 0.004). This study suggests that over 24 months, changes in bone density are minimal in patients on high-dose inhaled corticosteroids.