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背景:吸入性糖皮质激素是治疗哮喘的一线药物。但长期吸入大剂量糖皮质激素是否有引起骨质丢失的危险尚不能排除,尤其对女性哮喘患者。目的:了解国内女性哮喘患者长期吸入糖皮质激素是否会对骨密度和骨代谢产生影响。设计:以患者为观察对象,配对比较分析。对象:纳入40例女性哮喘患者为1998-02/2002-02在南京医科大学第一附属医院呼吸科门诊就诊者。均无长期全身使用激素史,且对实验目的知情同意。其中吸入糖皮质激素组(吸入组)20例每日坚持吸入激素≥5个月(年龄18～63岁,绝经5例),对照组20例(年龄18～60岁,绝经5例)采用常规平喘解痉药物治疗。对照组按年龄、性别和绝经情况与吸入组配对,平均人)。方法:采用双能X线骨密度仪测定患者L2～4椎体、股骨颈、股骨转子、股骨三角及股骨总量的骨密度,以绝对值和T评分(即与同性别成年人骨峰值相比的标准差)表示。同时与其同年龄、性别相应正常数据相比较,确定骨密度在这些部位的相对值。同时用放射免疫分析法等测定这些患者的血骨钙素以及碱性磷酸酶等指标,进行对比分析。主要观察指标:①两组患者骨密度比较。②两组血骨钙素以及碱性磷酸酶等指标比较。③吸入组日均吸入激素剂量和吸入激素的累积量与骨密度的相关性。结果:两组患者L2～4椎体、股骨颈、股骨转子、股骨三角及股骨总量的骨密度值及T评分差异不明显(P>0.05)。吸入组20例患者的上述5个部位骨密度值与其相应日均吸入糖皮质激素剂量之间无明显相关性(r=-0.325～-0.1102,P>0.05);L2～4椎体、股骨颈和股骨三角的骨密度值与吸入糖皮质激素累积量之间呈显著负相关(r=-0.495,-0.517,-0.531,P<0.05)。吸入组患者上述5个部位骨密度的T评分与其吸入糖皮质激素累积量无明显相关性(r=0.443～0.295,P>0.05)。吸入组股骨三角处的绝对骨密度值与其年龄呈显著负相关(r=-0.506,P<0.05),而对照组5个部位绝对骨密度值与其年龄之间无明显相关性(r=-0.079～0.326,P>0.05)。两组血清骨钙素及其他生化指标差异不明显(P>0.05)。结论:长期吸入糖皮质激素控制哮喘,对女性哮喘患者的骨密度和骨代谢一般不会产生明显影响,但长期吸入激素的女性哮喘患者随着吸入激素累积量的增加和或年龄的增长,引起骨质丢失的危险可能会增高。
Background: Inhaled glucocorticoids are first-line drugs for the treatment of asthma. However, long-term inhaled high-dose glucocorticoid whether there is the risk of bone loss can not be ruled out, especially for women with asthma. OBJECTIVE: To understand whether long-term inhaled glucocorticoid in Chinese women with asthma affects bone mineral density and bone metabolism. Design: The patient as the observation object, comparative analysis. PARTICIPANTS: Forty female patients with asthma were enrolled in Department of Respiratory Clinic of the First Affiliated Hospital of Nanjing Medical University from February 1998 to February 2002. No long-term systemic use of hormone history, and informed consent for the purpose of the experiment. Inhaled glucocorticoid group (inhalation group) 20 cases of daily inhaled hormone ≥ 5 months (age 18 to 63 years, 5 menopause), control group of 20 patients (age 18 to 60 years, 5 menopause) using conventional Anti-asthmatic antispasmodic drug treatment. The control group matched with inhalation group by age, sex and menopause, average person). Methods: BMD of L2-4 vertebral body, femoral neck, femoral trochanter, femur triangle and femur were measured by dual-energy X-ray absorptiometry. The absolute and T scores were compared with those of the same age adults Standard deviation) said. At the same time with their age, gender, the corresponding normal data to determine the relative value of bone mineral density in these areas. At the same time, radioimmunoassay and other indicators of these patients such as serum osteocalcin and alkaline phosphatase, comparative analysis. MAIN OUTCOME MEASURES: ① Comparison of bone mineral density between the two groups. ② two groups of blood osteocalcin and alkaline phosphatase and other indicators comparison. ③ Inhalation group, daily average inhaled hormone dose and cumulative amount of inhaled hormones and bone mineral density correlation. Results: The BMD and T scores of L2 ~ 4 vertebrae, femoral neck, femoral trochanter, femur triangle and femur in the two groups were not significantly different (P> 0.05). In the inhalation group, there was no significant correlation between the BMD of the above five sites and the corresponding daily inhaled glucocorticoid dose (r = -0.325-0.1102, P> 0.05) And femoral triangle bone mineral density value and cumulative glucocorticoid consumption was significantly negatively correlated (r = -0.495, -0.517, -0.531, P <0.05). There was no significant correlation between T score of bone mineral density and cumulative amount of glucocorticoid in inhalation group (r = 0.443-0.295, P> 0.05). There was a significant negative correlation between absolute bone mineral density (BMD) at the femoral triangle and its age (r = -0.506, P <0.05), while there was no significant correlation between absolute BMD at 5 sites and age ~ 0.326, P> 0.05). There were no significant differences in serum osteocalcin and other biochemical indexes between the two groups (P> 0.05). CONCLUSIONS: Long-term inhaled corticosteroids control of asthma generally does not have a significant effect on bone mineral density and bone metabolism in women with asthma, but long-term estrogen-inducing female asthma suffers from an increase in cumulative amounts of inhaled hormones and / or age The risk of bone loss may increase.