摘要
目的：了解吸入皮质类固醇治疗对成人骨骼的不良影响。方法：６３例男性分为２组：（１）吸入皮质类固醇治疗组２１例，其中 ４例为哮喘患者，１７例为 ＣＯＰＤ患者，吸入二丙酸倍氯米松（ＢＤＰ）６００～８００ ｕｇ／ｄ治疗豆个月至 ３年。（２）未吸入皮质类固醇治疗的ＣＯＰＤ患者４２例。３０例健康男性作为正常对照组。３组对象均用双能Ｘ线吸收骨密度仪（ＤＥＸＡ）行腰椎（Ｌ２、Ｌ３、Ｌ４、）和近端股骨（股骨颈、大转子、Ｗａｒｄ氏三角）骨密度（ＢＭＤ）测定，ＥＬＩＳＡ测定血清骨钙素（ＢＧＰ）、抗酒石酸盐酸性磷酸酶（ＴＲＡＰ）和晨尿胶原吡啶并酚（ＰｙＤ）、脱氧胶原吡啶并酚（Ｄ—ＰｙＤ）。结果：吸入类固醇治疗组与非类固醇治疗组比较，腰椎和近端股骨ＢＭＤ值均无显著差异。治疗组ＢＧＰ（５．５６±１．９７ ｎｇ／ｍｌ）较非治疗组（６．９１± ２．７０ｎｇ／ｍｌ）降低（Ｐ＜０．０５），治疗组ＴＲＡＰ（４．７８±０．７２ ｕ／Ｌ）较非治疗组（４．４１±０．６１ ｕ／Ｌ）升高（Ｐ＜０．０５）。结论：吸入ＢＤＰ治疗对成人哮喘和ＣＯＰＤ的近期骨密度值无明显影响，但可造成成骨功能受抑和破骨功能提高。
Objective: To investigate the risk of developing bone complications due to inhaled corticosteroids. Materials and Methods: We studied 63 male patients with chronic obstructive pulmonary disease (COPD) and asthma. Those in group A (n = 21) had been taking inhaled Bedomethasone Diapropionate (BDP) in a dosage of 600-800 ug per day for 1 month-3 years. Those in group B (n = 42) had not been treated with inhaled corticosteroids. Bone metabolism was assessed by measurement of serum ostrocalcin (BGP), serum tartrateresistant acid phosphatase (TRAP) and urinary pyridinoline (PyD). Bone mineral densities (BMD) were measured with dual - energy X - ray absorptiometry (DEXA) at the lumbar spine (L2- 4) and at the left proximal femur (the neck, Ward's triangle and the trochanteric region). Results: BMDs in group A were lower than normal, but had no significant change to compare with guoup B. Serum osteocalcin level in group A was significantly lower than that in group B (5. 56 ±1. 97 vs 6. 91 ±2. 70 ng/ml, P < 0. 05 ), serum TRAP level in group A was significantly higher (4. 78 ±0. 72 vs 4. 41 ±0. 61 u/L, P < 0. 05). Conclusion: The results showed that some markers of bone metabolism had changed in subjects using middle - dose inhaled steroids, although the therapy did not affect BMD.
