学龄前哮喘高危儿童停用氟替卡松2年后的生长情况
2011/10/13
摘要
背景:对于学龄前喘息反复发作的患儿,长期皮质激素吸入治疗对生长的影响尚不明确。
目的:本试验在患反复发作喘息的学龄前患儿中研究每日皮质激素吸入治疗2年对生长的影响。
方法:年龄为2~3岁、患有反复发作性喘息的儿童入选本项研究,这些患儿校正后的哮喘预测指数评分阳性。随机将患儿分为2年经氟氯化碳驱动的丙酸氟替卡松(176 μg/d)治疗组和单向阀面罩给予的安慰剂组,治疗结束后随访2年。检测站立时的身高,比较两组生长速度。
结果:作为一个队列研究总体,停药2年后,氟替卡松治疗组的生长速度与对照组并无显著差异(身高变化为-0.2 cm; 95% CI, -1.1 to 0.6)。采用事后分析,分析入选时体重低于15 kg、采用氟替卡松治疗的2岁儿童,显示与安慰剂组相比,具有较慢的线性生长(身高变化为-1.6 cm; 95% CI, -2.8 to -0.4; P =0.009)。
结论:喘息反复发作的学龄前儿童(哮喘高危儿童),采用176 μg/d经氟氯化碳给予的丙酸氟替卡松治疗,停药2年后,与安慰剂治疗2年相比,生长速度上无显著差异。然而,对亚组进行事后分析显示,年龄和体重相对整个研究队列较小的患儿,其线性生长速度较慢,这可能与氟替卡松暴露水平增加相关。
(刘国梁 审校)
J Allergy Clin Immunol. 2011 Aug 3. [Epub ahead of print]
Growth of preschool children at high risk for asthma 2 years after discontinuation of fluticasone.
Guilbert TW, Mauger DT, Allen DB, Zeiger RS, Lemanske RF Jr, Szefler SJ, Strunk RC, Bacharier LB, Covar R, Sorkness CA, Taussig LM, Martinez FD; Childhood Asthma Research and Education Network of the National Heart, Lung, and Blood Institute.
Source
Departments of Pediatrics, University of Wisconsin-Madison, Wis.
Abstract
BACKGROUND: The effect on linear growth of daily long-term inhaled corticosteroid therapy in preschool-aged children with recurrent wheezing is controversial.
OBJECTIVE: We sought to determine the effect of daily inhaled corticosteroid given for 2 years on linear growth in preschool children with recurrent wheezing.
METHODS: Children aged 2 and 3 years with recurrent wheezing and positive modified Asthma Predictive Index scores were randomized to a 2-year treatment period of chlorofluorocarbon-delivered fluticasone propionate (176 μg/d) or masked placebo delivered through a valved chamber with a mask and then followed for 2 years off study medication. Height growth determined by means of stadiometry was compared between treatment groups.
RESULTS: In the study cohort as a whole, the fluticasone group did not have significantly less linear growth than the placebo group (change in height from baseline difference, -0.2 cm; 95% CI, -1.1 to 0.6) 2 years after discontinuation of study treatment. In post hoc analyses children 2 years old who weighed less than 15 kg at enrollment and were treated with fluticasone had less linear growth compared with those treated with placebo (change in height from baseline difference, -1.6 cm; 95% CI, -2.8 to -0.4; P = .009).
CONCLUSION: Linear growth was not significantly different in high-risk preschool-aged children with recurrent wheezing treated with 176 μg/d chlorofluorocarbon-delivered fluticasone compared with placebo 2 years after fluticasone is discontinued. However, post hoc subgroup analyses revealed that children who are younger in age and of lesser weight relative to the entire study cohort had significantly less linear growth, possibly because of a higher relative fluticasone exposure.
J Allergy Clin Immunol. 2011 Aug 3. [Epub ahead of print]
上一篇:
哮喘的发病机理:我们目前对哮喘的理解告诉我们哪些新的治疗方法?
下一篇:
阻塞性睡眠呼吸暂停和胃食管反流对肥胖患者哮喘控制的影响