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【medical-news】支气管扩张患者肾上腺抑制及吸入
We identified 3 patients with bronchiectasis receiving inhaled corticosteroid (ICS) who had symptomatic adrenal suppression secondary to ICS. The prevalence of adrenal suppression is unknown in bronchiectasis. We examined the frequency of adrenal suppression and the impact of ICS use in bronchiectasis patients.
50 outpatients (33 receiving ICS) underwent a short synacthen test, and completed a St Georges Respiratory Questionnaire (SGRQ). Symptoms of adrenal suppression, steroid use, and lung function were compared between subjects who were suppressed and those who were not.
Adrenal suppression was evident in 23.5% of these who did not and 48.5% (p=0.043) of those who did receive ICS. Basal cortisol and the increments by which cortisol increased 30 minutes after synacthen were lower in suppressed compared with non-suppressed subjects. The incremental cortisol rise was negatively correlated with SGRQ impacts and total score, suggesting a worse quality of life in those who had an impaired adrenal response. The greatest frequency of generalised symptoms was seen in the suppressed group.
A significant proportion of subjects with bronchiectasis have evidence of adrenal suppression, and this is increased when ICS is also used. Impairment of the cortisol response to stimulation is associated with worse health status.
Eur Respir J 2008, doi:10.1183/09031936.00016908 支气管扩张患者肾上腺抑制及吸入皮质激素的影响
我们研究证实3例接受吸入皮质激素治疗的支气管扩张患者存在继发于吸入激素治疗的肾上腺抑制症状。支气管扩张病人肾上腺抑制的患病率尚不清楚。我们调查了支气管扩张患者肾上腺抑制的频率和吸入皮质激素的影响。
50名门诊患者（33人接受吸入皮质激素治疗）接受了短期二十四肽促皮质素检测，并填写圣乔治（St Georges）呼吸调查表(SGRQ).。比较肾上腺抑制和无肾上腺抑制患者的肾上腺抑制症状，激素使用和肺功能。
不使用吸入皮质激素的支气管扩张患者中肾上腺抑制者占23.5%，而使用者中占48.5%(p=0.043) 。与非抑制患者相比，抑制患者基础皮质激素水平和二十四肽促皮质激素应用30分钟后皮质激素增加水平均降低。皮质激素增量水平与SGRQ表影响及总分成反比，证实肾上腺受损患者生活质量恶化。在肾上腺抑制患者中常见症状发作频繁。
在支气管扩张患者中，很大一部分存在肾上腺抑制，在使用吸入皮质激素后这一比例更高。皮质激素对刺激反应性的下降与生活质量的恶化有关。
欧洲呼吸病学杂志，2008年 [标签:content1][标签:content2]
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作者:admin@医学,生命科学 2011-07-09 12:04
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