一个回顾性研究断奶糖皮质类药物和恢复的下丘脑-垂体-上腺轴
Muhammad Fahad Arshad1,2, Charlotte Elder1,3, John Newell-Price1,2
1Division of Clinical Medicine, School of Medicine & Population Health, University of Sheffield, Sheffield S10 2RX, UK.
The Journal of clinical endocrinology and metabolism
|February 1, 2024
概括
维持患者每天服用一次普雷迪尼索隆的治疗有助于在葡萄糖皮质醇诱导的上腺功能不全 (AI) 中恢复下丘脑-垂体-上腺 (HPA) 轴. 转换为皮对HPA轴功能恢复没有益处.
科学领域:
- 内分泌学 在内分泌学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 葡萄糖皮质类药物抑制下丘脑-垂体-上腺 (HPA) 轴,导致三级上腺功能不充分 (AI).
- 当前的临床实践缺乏关于是否继续使用普雷尼索隆或转换为皮质,当断奶患者脱离葡萄糖皮质醇的共识.
研究的目的:
- 调查长期服用普得尼索隆的患者的HPA轴恢复率.
- 评估HPA轴恢复转换为皮的结果.
主要方法:
- 对206名长期服用普得尼索隆的患者进行了回顾性队列研究,这些患者接受了HPA轴测试.
- 通过 adrenocorticotrophic激素 (ACTH) 刺激试验测量HPA轴恢复.
- 对比剂量匹配的普雷迪尼索隆子组与转换为皮的子组.
主要成果:
- 在接受普得尼索隆治疗的患者中,HPA轴的整体恢复率为66.5% (137/206).
- 剂量匹配分析显示,与水皮质组 (15%,P = .008) 相比,在普得尼索隆组 (70%) 的康复率显著更高.
- 在剂量匹配组之间,年龄,基线皮质醇,葡萄糖皮质醇持续时间或基线ACTH之间没有显著差异.
结论:
- 每天服用一次的普雷迪尼索隆可以在断奶期间促进HPA轴恢复,在葡萄糖皮质醇诱导的AI患者中.
- 转换为每天多次给药的皮似乎没有为HPA轴恢复提供优势.
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