在停止服用普雷尼索隆后,上腺功能和缺乏症症状的变化
Simon Bøggild Hansen1,2, Anja Fenger Dreyer3,4, Nanna Thurmann Jørgensen5,6
1Aarhus University Hospital, Department of Endocrinology and Internal Medicine, Aarhus, Denmark.
JAMA network open
|March 18, 2025
概括
葡萄糖皮质类药物诱导的上腺功能衰竭 (GIAI) 在停止服用普得尼索隆后影响了1.9%的患者. 症状很常见,但GIAI很少见,这表明针对有症状的个体进行查.
科学领域:
- 内分泌学 在内分泌学.
- 类风湿病学 类风湿病学
- 临床药理学 临床药理学
背景情况:
- 葡萄糖皮质激素 (GC) 治疗是广泛使用的,但可能导致GC诱导的上腺功能不全 (GIAI).
- 目前GIAI的实际患病率和临床意义尚不清楚,需要进一步调查.
研究的目的:
- 在停止服用普得尼索隆后,确定多肌痛性风湿症和/或巨细胞动脉炎患者中GIAI的患病率.
- 评估与GIAI相关的症状,并确定相关因素.
主要方法:
- 这是一项涉及267名先前接受过普得尼索隆治疗的患者的横截式多中心研究.
- GIAI是通过简短的皮质激素刺激试验 (SST) 诊断出来的.
- 用AddiQoL-30问卷评估了上腺功能不充分的症状.
主要成果:
- 根据SST结果,只有1.9%的患者呈现GIAI.
- 然而,34%的人报告了与上腺功能不充分相一致的症状 (AddiQoL-30得分≤85).
- 症状患者的基底皮质醇水平较低,女性性别,体脂增加和肌肉功能减少等因素与生活质量降低有关.
结论:
- 在这种队列中,在停止使用普得尼索隆后,GIAI的患病率很低 (1.9%),与之前的一些报告相反.
- 不建议对GIAI进行例行查;重点应放在有明显症状的患者身上.
- 上腺功能缺陷症状的高患病率凸显了类固醇戒断的挑战,需要进一步研究.
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