The use of inhaled corticosteroids and the risk of adrenal insufficiency
The use of inhaled corticosteroids and the risk of adrenal insufficiency
复制标题
DOI：
10.1183/09031936.00080912
复制
发表时间：
2013-07-01
影响因子：
24.3
通讯作者：
Ernst, Pierre
中科院分区：
文献类型：
--
作者：
Lapi, Francesco;Kezouh, Abbas;Ernst, Pierre
肾上腺功能不全是吸入皮质类固醇 (ICS) 治疗的潜在并发症。尽管之前的研究发现氟替卡松（一种更有效的 ICS）导致肾上腺功能不全的风险最高，但这些结果可能是由于通道偏差和同时暴露于口服皮质类固醇所致。我们通过使用 1990 年至 2005 年期间因呼吸系统疾病接受治疗的一组患者重新研究了使用 ICS 与肾上腺功能不全之间的关系，这些患者是在加拿大魁北克省的医疗保健数据库中确定的，随访至 2007 年。在该队列中进行了巢式病例对照分析。肾上腺功能不全病例与最多 10 名对照者相匹配。共鉴定出 392 例（发病率为每 10 000 人年 1.1 例）。尽管目前所有 ICS 使用者的肾上腺功能不全发生率并未显着升高，但接受最高剂量的患者显示出更高的风险（OR 1.84，95% CI 1.16-2.90）。一致地，事件前一年累积的 ICS 剂量最高三分位数（OR 1.90，95% CI 1.07-3.37）估计风险增加。高剂量 ICS 似乎是肾上腺功能不全的重要独立危险因素。开出此类剂量 ICS 的医生应对其患者肾上腺功能不全的体征和症状敏感。
Adrenal insufficiency is a potential complication of therapy with an inhaled corticosteroid (ICS). Although prior studies found the highest risk of adrenal insufficiency with fluticasone, a more potent ICS, these results might be explained by a channelling bias and concomitant exposure to oral corticosteroids.We re-examined the relationship between the use of ICSs and adrenal insufficiency by using a cohort of patients treated for respiratory conditions during 1990-2005, identified in the healthcare databases from the province of Quebec, Canada, with follow-up until 2007. A nested case-control analysis was performed within this cohort. Cases of adrenal insufficiency were matched with up to 10 controls.392 cases were identified (incidence rate 1.1 per 10 000 person-years). Although the rate of adrenal insufficiency was not significantly higher among all current users of ICSs, patients receiving the highest dosages showed a greater risk (OR 1.84, 95% CI 1.16-2.90). Consistently, an increased risk was estimated for the highest tertile of ICS dose (OR 1.90, 95% CI 1.07-3.37) cumulated in the year before the event.ICS at high doses appear to be a significant independent risk factor for adrenal insufficiency. Physicians prescribing ICS at such dosages should be sensitive to the signs and symptoms of adrenal insufficiency in their patients.