系统性葡萄糖皮质激素治疗后的上腺功能不全:系统性审查和元分析
Jonathan Bowley1, Sophie Shallish2, Natasha Smyth3
1Southmead Hospital, North Bristol NHS Trust, UK.
European journal of internal medicine
|January 11, 2026
概括
在葡萄糖皮质醇 (GC) 治疗后,上腺功能不足 (AI) 是常见的,影响30%的患者. 在停止治疗后至少15天,减少GC剂量和对AI进行测试可以减少其流行率.
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:
- 上腺功能不足 (AI) 是葡萄糖皮质醇 (GC) 治疗的常见并发症.
- 需要澄清人工智能和GC方案的预测因素,以减轻风险.
- 之前的系统性审查缺乏具有明确的GC暴露的研究.
研究的目的:
- 系统地审查与精确定义的葡萄糖皮质激素暴露的研究,以评估AI患病率和预测因素.
- 确定可能减轻AI风险的GC方案和测试策略.
主要方法:
- 使用Embase,Web of Science和MEDLINE,对自2000年以来发表的研究进行系统审查.
- 包括接受协议化全身GC疗程的成年参与者,并通过ACTH刺激测试对AI进行评估.
- 数据的元分析,包括AI流行率,GC剂量,逐渐减少,持续时间和结果评估时间.
主要成果:
- 12项研究 (1170名参与者) 符合纳入标准;整体AI患病率为30% (19-45%).
- 人工智能患病率差异很大 (0-70%) 并与诊断,途径,持续时间或研究质量没有一致的联系.
- 与停止 (48%) 测试相比,AI在GC逐渐缩小 (p < 0.01) 和延迟测试 (停止后≥15天:15%) 的情况较少.
结论:
- 在系统性GC使用后,AI是常见的和可变的.
- 显然,GC的逐渐缩减和延迟的终止后测试可以减少观察到的AI患病率.
- 没有特定的GC疗法可靠地预防AI.
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