在多发性肌痛类风湿症患者中重复进行短期皮质激素检测
Tobias Gaster1,2, Andreas Wiggers Nielsen1,2,3, Simon Bøggild Hansen2,4
1Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
Rheumatology (Oxford, England)
|November 20, 2025
概括
葡萄糖皮质类药物诱导的上腺功能衰竭 (GIAI) 在多发性肌痛性风湿症 (PMR) 患者中很常见,但在停止治疗后通常可逆. 治疗后,上腺功能可能无法完全恢复到基线水平.
科学领域:
- 内分泌学 在内分泌学.
- 类风湿病学 类风湿病学
- 药理学 药理学是指药理学的学科.
背景情况:
- 多发性肌痛性风湿症 (PMR) 通常用葡萄糖皮质类药物 (GCs) 治疗.
- GC治疗可能导致上腺功能不充分.
- 在PMR患者中,GC诱导的上腺功能衰竭 (GIAI) 的患病率和可逆性需要进一步调查.
研究的目的:
- 为了研究PMR患者的上腺功能.
- 为了确定在GC治疗的前18个月内GIAI的患病率.
- 评估GC停止后GIAI的可逆性.
主要方法:
- 新诊断的PMR患者在多个时间点进行了短暂的皮质otropin测试.
- 在GC治疗之前进行了测试,并在10周,6个月,12个月和18个月后进行了测试.
- GIAI被定义为刺激的血清皮质醇水平低于420nmol/l.
主要成果:
- 刺激皮质醇水平在第6个月显著下降,与GC剂量呈反向关系.
- 在第6个月,GIAI的患病率达到25%的峰值,大多数病例在12个月内消失.
- 在GC停止后,上腺功能并不总是达到治疗前的水平.
结论:
- 在接受GC治疗的PMR患者中,GIAI是频繁但可逆的.
- 这些发现支持考虑在PMR患者的压力期间增加GC剂量.
- 在PMR中计划GC停止后,用于GIAI诊断的例行短期皮质激素检测目前没有数据证明是合理的.
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