吸入、鼻用和局部皮质类固醇负担及其与皮质类固醇相关不良事件的关联
Inhaled, nasal and topical corticosteroid burden and association with corticosteroid-associated adverse events.
文献信息
| PMID | 42854835 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Kjell Erik Julius Håkansson |
| 作者单位 | Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark. Electronic address: kjell.erik.julius.haakansson@regionh.dk. |
| 期刊 | The journal of allergy and clinical immunology. In practice |
| SCI 分区 | Q1 |
| IF | 7.7 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻科 |
中文摘要
背景： 2型炎症相关疾病患者常接受多种剂型的皮质类固醇治疗。长期使用局部皮质类固醇联合方案的风险尚不明确。
目的： 利用丹麦全国性数据库，比较局部皮质类固醇暴露与非使用者之间11种皮质类固醇暴露相关疾病的关联，并探讨暴露个体的剂量-反应关系。
方法： 2000-2012年期间未使用过全身性皮质类固醇的成年人，若曾领取吸入、鼻用和/或局部皮质类固醇，则与非起始使用者进行匹配，并随访长达23年。总体（吸入、鼻用和局部）暴露量按6个月期间计算，分为低（<1.25每日泼尼松龙等效mg）、中（1.25-2.5 mg）或高（>2.5 mg）。采用具有时变效应的竞争风险Cox模型，结果以每增加一个6个月暴露期的HR表示。
结果： 共纳入292,393名局部皮质类固醇使用者（平均年龄45岁，47.7%为女性）。皮质类固醇暴露相关疾病的发生率总体较低，但使用者的所有疾病亚分布HR均较高，白内障和肥胖的范围为1.4至3.8（p<0.001）。对于局部皮质类固醇使用者，每6个月暴露的风险增加见于骨质疏松症（低-高剂量：HR 1.01-1.10）、肥胖（1.03-1.03）和肺炎（1.03-1.15）。心血管疾病、心力衰竭、白内障和胃食管反流病的风险仅在高剂量暴露时增加，每增加一个6个月暴露期的HR分别为1.03、1.02、1.04和1.04。按剂型分层，高剂量吸入和局部皮质类固醇显示出最强的关联。
结论： 在使用局部皮质类固醇的个体中，总体皮质类固醇负担，包括较短时间的高剂量暴露，与皮质类固醇暴露相关不良事件相关，尽管发生率和风险比总体较低。
英文摘要
BACKGROUND: Patients with type 2 inflammation-associated diseases are often treated with multiple formulations of corticosteroids. Long-term risks of using combinations of local corticosteroids are poorly characterised.
OBJECTIVE: Using Danish nationwide databases, investigate associations between local corticosteroid exposure and 11 corticosteroid exposure-associated conditions compared to non-users, and eventual dose-response relationship for exposed individuals.
METHODS: Systemic corticosteroid-naïve adults who redeemed inhaled, nasal and/or topical corticosteroids 2000-2012 were matched with non-initiators and followed for up to 23 years. Overall (inhaled, nasal and topical) exposure was calculated for 6-month periods as low (<1.25 daily prednisolone-equivalent mg), moderate (1.25-2.5 mg) or high (>2.5 mg). Competing risk Cox models with time-varying effects were used, presented as HR per additional 6-month period of exposure.
RESULTS: Overall, 292,393 local corticosteroid users were included (mean age 45, 47.7% female). Corticosteroid exposure-associated condition incidences were generally low, but all conditions had higher subdistribution-HRs in users, ranging from 1.4 to 3.8 for cataracts and obesity (p<0.001).For local corticosteroid users, increased risk per 6-month exposure was observed for osteoporosis (low-high dose: HRs 1.01-1.10), obesity (1.03-1.03) and pneumonia (1.03-1.15). Risk of cardiovascular disease, heart failure, cataract and gastroesophageal reflux disease increased with high-dose exposure only at HRs 1.03, 1.02, 1.04 and 1.04 per additional 6-month period of exposure, respectively.Stratified by formulation, high-dose inhaled and topical corticosteroids demonstrated the strongest associations.
CONCLUSION: In individuals using local corticosteroids, the overall corticosteroid burden, including shorter periods of high-dose exposure, associates with corticosteroid exposure-associated adverse events albeit with generally low incidence and hazard.