在巨细胞动脉炎中上腺功能不全
Georgina Ducker1, Ketan Dhatariya2,3, Chetan B Mukhtyar1
1Vasculitis Unit, Department of Rheumatology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK.
Rheumatology advances in practice
|June 10, 2025
概括
需要长期类固醇替代的上腺功能不充分是巨细胞动脉炎 (GCA) 患者治疗诺维奇普雷迪尼索隆治疗方案不常见. 序列皮质醇测试有效地识别了需要进一步评估上腺功能的患者.
科学领域:
- 内分泌学 在内分泌学.
- 类风湿病学 类风湿病学
- 内部医学 内部医学
背景情况:
- 巨细胞动脉炎 (GCA) 是一种全身性血管炎,主要影响大动脉.
- 长期使用葡萄糖皮质激素治疗,包括普雷尼索隆,是GCA的主要治疗方法.
- 葡萄糖皮质激素的使用可能导致上腺功能不充分,需要仔细监测.
研究的目的:
- 为了确定GCA患者的上腺功能缺陷的频率,用诺维奇普雷迪尼索隆治疗方案治疗.
- 评估对上腺功能的连续测试策略的有效性.
主要方法:
- 分析了353名接受诺维奇普雷迪尼索隆治疗的GCA患者队列.
- 作为初步测试,上腺功能使用上午9点血清皮质醇水平进行评估.
- 皮质醇水平较低的患者经历了动态测试,使用上皮质激素 (ACTH) 刺激.
主要成果:
- 在76名接受测试的患者中,8/35人 (22.8%) 根据初始皮质醇水平显示上腺功能不足.
- 进一步的ACTH刺激显示,有8/35名患者 (22.8%) 的上腺储备不足.
- 总共有15/353名患者 (4.2%) 因上腺功能不全而需要长期的类固醇替代治疗.
结论:
- 需要长期使用类固醇替代的上腺功能不全在接受诺维奇普雷迪尼索隆治疗方案的GCA患者中不常见.
- 在这群人群中,用早上9点的血清皮质醇和ACTH刺激进行序列测试是评估上腺功能的有效策略.
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