在严重喘中持续长期的HPA轴抑制维护后口服皮质类固醇戒断:生化评估至关重要
Liam Coyle1, Christian Schnier1, P Jane McDowell2
1Wellcome-Wolfson Institute for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queens University Belfast, Belfast, UK.
The journal of allergy and clinical immunology. In practice
|February 25, 2026
概括
许多接受维持性口服皮质类固醇 (mOCS) 的严重喘患者在停药后经历了持续的上腺功能不充分. 无症状患者可能会受到伤害,如果没有生物化学监测,以抑制下丘脑-垂体-上腺轴 (HPA轴).
科学领域:
- 内分泌学 在内分泌学.
- 肺部病理学 肺部病理学
- 药理学 药理学是指药理学的学科.
背景情况:
- 在严重喘 (SA) 中,维持口服皮质类固醇 (mOCS) 停药缺乏共识,特别是对下丘脑-垂体-上腺轴 (HPA轴) 的抑制.
- 在接受长期皮质类固醇治疗的SA患者中,上腺功能不全是一个重大问题.
研究的目的:
- 为了确定从mOCS退出的SA患者长期随访后持续的HPA轴抑制的患病率.
- 为了确定持续的HPA轴抑制的预测因子,并使用短同位素测试 (SST) 验证早晨皮质醇切断.
主要方法:
- 追溯分析来自北爱尔兰的英国严重喘登记处 (UKSAR) 的数据.
- 通过生物化学测试评估HPA轴功能,包括早晨皮质醇水平和SST.
主要成果:
- 在基线时,83%的患者表现出上腺功能不足;经过中位数为58.5个月后,27%的患者表现出持续的上腺功能不足.
- 在那些患有基线上腺功能缺陷的人中,68%的HPA轴功能恢复,恢复时间平均为21个月.
- 与康复的患者相比,持久性上腺功能不充分与显著较低的基线皮质醇水平有关 (43 nmol/L与165 nmol/L).
结论:
- 在严重喘患者中,显著比例的患者在停止使用mOCS时表现出持续的上腺功能不充分.
- 持续抑制HPA轴的无症状患者,如果不通过连续生化监测识别,就有危害的风险.
- 这些发现对治疗需要长期使用皮质类固醇治疗的其他疾病有意义.
相关概念视频
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
1.7K
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
1.7K
01:26COPD: Management Using Bronchodilators and Corticosteroids
953
Chronic obstructive pulmonary isease (COPD) involves a group of progressive lung disorders characterized by persistent airflow limitation and chronic respiratory symptoms. Asthma-COPD Overlap Syndrome (ACOS), encompassing features of both asthma and Chronic obstructive pulmonary disease (COPD), is a group of progressive lung disorders that includes chronic bronchitis, emphysema, and refractory (non-reversible) asthma. ACOS leads to complex clinical presentations that combine the inflammatory...
953
01:37Hypothalamic-Pituitary Axis
68.5K
The response to stress—be it physical or psychological, acute or chronic—involves activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis. The HPA axis is part of the neuroendocrine system because it involves both neuronal and hormonal communication. Its function is to regulate homeostatic systems—metabolic, cardiovascular, and immune—providing the necessary means to respond to a stressor.
68.5K
01:25Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
2.0K
Asthma is a chronic respiratory condition for which new therapeutic avenues, including anti-inflammatory drugs like mast cell stabilizers and anti-IgE treatments, continue to be developed.
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...
2.0K
01:19Antiasthma Drugs: Leukotriene Modifiers
2.0K
Leukotriene modifiers, or cysteinyl leukotriene receptor antagonists, are medications used to manage chronic asthma. These agents target specific inflammatory mediators produced during arachidonic acid metabolism, an essential process in generating inflammation in the body.
Leukotriene modifiers work through two distinct mechanisms:
Leukotriene modifiers work through two distinct mechanisms:
2.0K
01:30Asthma-IV: Diagnostic and Management
3.2K
The diagnosis and management of asthma are comprehensive, encompassing clinical assessments, lung function tests, and pharmacological interventions. Here's an overview:
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
3.2K