雾化吸入糖皮质激素对支气管哮喘患儿下丘脑－垂体－肾上腺轴功能的影响

Objective To evaluate the effect of nebulized corticosteroid-Budesonide (BUD) on hypothalamic-pituitary-adrenal axis (HPAA) in children with asthma. Methods 1. Thirty children with mild to moderate persistent asthma (observation group) were treated with inhaled BUD, before treatment and 6 weeks after treatment, the levels of serum cortisol and 24-hour urine free cortisol (24 h-UFC), were measured and compared with those in healthy children, 12 weeks after treatment another observation of 24 h-UFC was made in BUD treated asthmatic children. 2. Sixty asthmatic children who had regularly treated with BUD through jet nebulizer for more than 6 months were divided into 2 groups: BUD-250 group (those asthmatic children who had received 250 μg/d of BUD for more than 3 months) and BUD 500 group (those asthmatic children who had received 500 μg/d of BUD for more than 3 months) according to the given dose of BUD at 3 months just before our investigation. The levels of serum cortisol and 24-UFC were measured in both groups. Results 1. In asthmatic children group, before treatment and 6 weeks after the nebulized BUD treatment, the levels of serum cortisol was (251.94 ± 15.79) mmol/L and (228.83 ± 16.51) nmol/L, Before treatment and 6, 12 weeks after the nebulized BUD treatment, the 24 h-UFC/Cr was (376.08 ± 66.80) nmol/mmol, (361.96 ± 26.96) nmol/mmol and (358.05 ± 35. 41) nmol/mmol, respectively. There was no significant difference statistically before and after the treatmentf P(subscript a)＞0.05). The levels of serum cortisol and 24 h-UFC/Cr in healthy children were (238.76 ± 9.30) nmol/L and (333.51 ± 27.87) nmol/mmol, respectively. Compared with those in asthmatic children, no matter whether it was before or after the treatment, no significant difference was found statistically in serum cortisol and 24 h-UFC/Cr (p.＞0.05). There was no significant difference statistically between normal children and asthmatic children who had received nebulized BUD treatment for 12 weeks (P(subscript a)＞0.05).2. In BUD-250 group and BUD-500 group, the levels of serum cortisol was (255.91±24.02) nmol/L and (264.38±17.36) nmol/L, respectively, and the 24 h-UFC/Cr was (396.44 ± 55.33) nmol/rnmol and (361.73 ± 33.60) nmol/mmol, respectively. Compared with the serum cortisol [(236.25 ± 9.76) nmol/L] and the 24 h-UFC/Cr [(343.42 ± 27.32) nmol/mmol] in normal children, no significant difference statistically were found (P(subscript a)＞0.05). Conclusion Nebulized BUD in recommended dose as long-term treatment would not significantly effective on HPAA of children with asthma.