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目的 观察持续小剂量吸入糖皮质激素对哮喘患儿骨代谢指标和骨密度的影响。方法 随机将 4 5例 5～ 8岁哮喘缓解期患儿分 3个开放治疗组 ,吸入糖皮质激素 (布地奈德 )分别为 10 0、2 0 0、30 0 μg/d ,持续 12个月。于治疗开始 ,6、12个月行临床评估和肺功能FEV1测定 ;检测血骨钙素 (OST)、胰岛素样生长因子 1(IGF 1)、骨碱性磷酸酶 (BALP)和尿脱氧吡啶 (DPD) /尿肌酐 (Cr)水平。用双能X线骨密度仪监测骨密度 (BMD)。结果 哮喘患儿治疗后临床评分和肺功能FEV1明显改善 ;血OST稍高于正常儿童对照组 ,但无显著差异 ;血BALP显著高于正常对照组 ;血IGF 1水平与同龄正常儿童比较显著增高 ;尿DPD/Cr水平显著低于正常对照组 ;治疗前后患儿股骨近端 (股骨颈 ,大转子 ,Ward′s三角 )、脊柱区域 (2～ 4 )和前臂 (前臂远端和近侧端 )的BMD无显著降低。结论 持续小剂量吸入糖皮质激素对哮喘患儿的骨代谢指标和BMD无明显抑制影响。
Objective To observe the effect of continuous low dose inhaled glucocorticoid on bone metabolism index and bone mineral density in children with asthma. Methods A total of 45 children with asthma remission of 5 to 8 years old were randomly divided into 3 open treatment groups. The inhaled glucocorticoid (budesonide) was 10 0, 200, 030, 0 μg / day for 12 months . At the beginning of treatment, clinical evaluation and pulmonary function FEV1 determination were performed at 6 and 12 months. Blood levels of osteocalcin (OST), insulin-like growth factor 1 (IGF 1), bone alkaline phosphatase (BALP) and urine deoxypyridine DPD) / urinary creatinine (Cr) levels. Bone mineral density (BMD) was monitored using dual energy X-ray absorptiometry. Results The clinical score and pulmonary function FEV1 in asthmatic children were significantly improved after treatment. The blood OST was slightly higher than that in normal children, but there was no significant difference. The blood BALP was significantly higher than that in normal control group. The serum IGF1 level was significantly higher than that in normal children ; Urinary DPD / Cr levels were significantly lower than those in the normal control group; proximal femur (femoral neck, greater trochanter, Ward’s triangle), spine region (2-4) and forearm (forearm distal and proximal ends ) Had no significant decrease in BMD. Conclusion Continuous low dose inhaled glucocorticoid has no obvious effect on bone metabolism index and BMD in children with asthma.