哮喘联盟

   摘要
   本试验共纳入44例糖皮质激素中位治疗时间6.5年的哮喘患者，以研究吸入糖皮质激素治疗对骨密度的影响。与对照组相比，只有50岁以下患者的脊柱(11.3%, p = 0.013) 和臀部(8.8%, p = 0.044) 的骨密度有所降低，而50岁以上患者的骨密度并无显著降低。
   前言：既往关于吸入糖皮质激素(ICS)治疗对哮喘患者骨密度影响的研究结果是不一致的。本项病例对照研究的目的在于比较使用吸入糖皮质激素治疗的哮喘患者和相同年龄组的健康对照者的骨密度状况。
   方法：腰椎(LS)和股骨颈(FN)的骨密度测定采用双能X线吸收法(DEXA)。分别比较小于50岁年龄组和大于50岁年龄组的哮喘患者和对照者的腰椎(LS)及股骨颈(FN)的骨密度gr/cm2、骨密度T评分、骨密度Z评分、骨质疏松症频率（定义为骨密度T评分≤-2.5）和骨密度Z评分＜-1的频率。
   结果：本研究共纳入44例吸入糖皮质激素中位治疗时间6.5年的哮喘患者(女性占63.6%)和50例对照者(女性占69.4%)，两组的平均年龄分别为49.2 ± 9.5岁(p = 0.38)和47.4 ± 10.5岁(p = 0.35)。哮喘患者总体的腰椎(LS)骨密度gr/cm2和股骨颈(FN)的骨密度gr/cm2较对照组分别低6%(p = 0.065)和5.9%(p = 0.09)。在小于50岁的年龄组中，哮喘患者的平均腰椎(LS)骨密度gr/cm2较对照组低11.3% (p = 0.013)，平均股骨颈(FN)骨密度较对照组低8.8%(p = 0.044)，腰椎和股骨颈的平均骨密度T评分和骨密度Z评分也低于对照组(p值分别为 0.013和0.01)，两组骨质疏松症频率没有差异，但是哮喘患者骨密度Z评分＜-1的频率更高(优势比(OR) = 6.57,95 % CI, 1.8-23.9, p = 0.004)。在大于50岁的年龄组中，哮喘患者和对照者腰椎及股骨颈的骨密度减少没有显著差异。
   结论：本研究显示：使用吸入糖皮质激素治疗的哮喘患者骨密度降低与年龄相关，并且年纪较轻患者的骨密度损失风险更高。这些发现表明小于50岁患者尤其应该采取预防措施。
 

（苏欣 审校）
Osteoporos Int. 2015 Apr 10. [Epub ahead of print]

 

Impact of treatment with inhaled corticosteroids on bone mineral density of patients with asthma: related with age.
 

Monadi M1, Javadian Y, Cheraghi M, Heidari B, Amiri M.
 

Abstract
The effect of inhaled corticosteroid on bone mineral density (BMD) was investigated in 44 asthmatic patients after median treatment duration of 6.5 years. Compared with controls, BMD decreased only in patients aged <50 years in both the spine (11.3 %, p = 0.013) and hip (8.8 %, p = 0.044), whereas in patients ≥50 years BMD did not decrease significantly.
INTRODUCTION:The results of studies which addressed the impact of inhaled corticosteroid (ICS) therapy on BMD of patients with asthma are conflicting. This case-control study aimed to compare BMD status in ICS user with asthma with healthy controls according to age.
METHODS:BMD at the lumbar spine (LS), femoral neck (FN) was measured by dual energy X-ray absorptiometry (DEXA). Patients and controls were compared according to BMD gr/cm2, BMD T-score, BMD Z-score, frequency of osteoporosis (defined as BMD T-score ≤-2.5), and frequency of patients with BMD Z-score <-1 at LS and FN with regard to age <50 and ≥50 years old.
RESULTS:Forty-four ICS user patients (females 63.6 %) with median treatment duration of 6.5 years and 50 controls (females, 69.4 %) with respective mean age of 49.2 ± 9.5 and 47.4 ± 10.5 years (p = 0.38 and p = 0.35) entered the study. Overall LS-BMD and FN-BMD gr/cm2 in total patients were lower than in controls by 6 % (p = 0.065) and 5.9 % (p = 0.09), respectively. In patients <50 years, mean LS-BMD gr/cm2 was lower than controls by 11.3 % (p = 0.013) and FN-BMD by 8.8 % (p = 0.044). Mean BMD T-score and BMD Z-score in both measurement sites were also lower than controls (p = 0.013 and 0.01, respectively. Frequency of osteoporosis did not differ but frequency of patients with BMD Z-score <-1 was significantly higher in patients (odds ratio (OR) = 6.57 95 % CI, 1.8-23.9, p = 0.004). In age group ≥50 years old, reduction of BMD in both measurement sites did not reach to a significant level.
CONCLUSION:This study indicates that BMD reduction in ICS user with asthma is dependent on age and appears that younger patients are at greater risk of BMD loss. These findings suggest preventive measures particularly in patients <50 years.
 

Osteoporos Int. 2015 Apr 10. [Epub ahead of print]