吸入糖皮质激素对哮喘儿童骨龄及生长发育的影响

Effects of inhaled corticosteroids on bone age and growth in children with asthma

摘要:

目的：长期吸入糖皮质激素是哮喘的首选治疗方法，但国内外对于年幼儿童长期吸入糖皮质激素治疗的安全性仍有争议，本研究旨在探讨支气管哮喘患儿吸入糖皮质激素对骨龄及生长发育的影响。方法：73例支气管哮喘患儿给予丙酸氟替卡松吸入治疗，剂量250 μg/d，3个月后减量1/3续用3个月，再减为125 μg/d续用6个月，治疗后观察疗效，治疗前后分别测量骨龄、身高、体重。结果：入选患儿治疗后身高、体重及RUS骨龄增长与正常儿童差异无统计学意义（P>0.05）；体重指数(BMI)治疗前后差异无统计学意义（P>0.05）；治疗前后C骨龄与年龄差值分别为-0.2（-0.6，0.8）岁、-0.5（-1.0、0.6)岁，治疗后明显比治疗前延迟（P<0.05）。结论：哮喘患儿吸入糖皮质激素治疗 1年对C骨龄发育有一定抑制作用，对RUS骨龄、身高、体重及BMI无明显影响；长期糖皮质激素治疗的患儿应监测生长发育状况。

Abstract:

OBJECTIVE: Long-term inhaled corticosteroids are the preferred treatment for asthma, but their safety still controversial. The aim of the present study was to explore the effects of inhaled corticosteroids on bone age and growth in children with asthma. METHODS: Seventy-three children with asthma received inhaled fluticasone treatment at a starting dosage of 250 μg/d for 3 months, when the dosage was reduced by a third. Three months later, the patients were treated with fluticasone at a dosage of 125 μg/d for 6 months. Bone age, heights and weights were measured before and one year of treatment. RESULTS: The increase in the heights, weights and RUS (radius, ulna and short finger bones) bone age of the children with asthma after one year of treatment was not significantly different from healthy children. There were no significant differences in body mass index (BMI) before and after one year of treatment, however the level of carpal bone age ［-0.2(-0.6,0.8) years］ was delayed after therapy compared to before treatment ［-0.5(-1.0,0.6) years］ (P<0.05). CONCLUSIONS: Treatment with inhaled corticosteroids for 1 year may suppress the level of carpal bone age, but the level of RUS bone age, heights, weights and BMI are not affected. It is necessary to monitor the growth of children with asthma who receive long-term inhaled corticosteroid treatment.