Tuberculosis and Respiratory Diseases
- 제44권5호
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- Pages.1063-1071
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- 1997
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- 1738-3536(pISSN)
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- 2005-6184(eISSN)
단기간 Fluticasone Propionate 투여 용량에 따른 가저 코르티솔 농도의 변화
Effect of Short Term Treatment with Different Dosage of Inhaled Flucatisone Propionate on Basal Cortisol Concentration
- 김현중 (전북대학교 의과대학 내과학교실) ;
- 김형식 (전북대학교 의과대학 내과학교실) ;
- 이홍 (전북대학교 의과대학 내과학교실) ;
- 문성기 (전북대학교 의과대학 내과학교실) ;
- 임석태 (전북대학교 의과대학 내과학교실) ;
- 박지현 (전북대학교 의과대학 내과학교실) ;
- 이흥범 (전북대학교 의과대학 내과학교실) ;
- 이용철 (전북대학교 의과대학 내과학교실) ;
- 이양근 (전북대학교 의과대학 내과학교실)
- Kim, Hyun-Jung (Department of Internal Medicine, Chonbuk National University Medical School, Chonbuk University) ;
- Kim, Hyoung-Sik (Department of Internal Medicine, Chonbuk National University Medical School, Chonbuk University) ;
- Lee, Hong (Department of Internal Medicine, Chonbuk National University Medical School, Chonbuk University) ;
- Moon, Sung-Gi (Department of Internal Medicine, Chonbuk National University Medical School, Chonbuk University) ;
- Lim, Seok-Tae (Department of Internal Medicine, Chonbuk National University Medical School, Chonbuk University) ;
- Park, Ji-Hyun (Department of Internal Medicine, Chonbuk National University Medical School, Chonbuk University) ;
- Lee, Heung-Bum (Department of Internal Medicine, Chonbuk National University Medical School, Chonbuk University) ;
- Lee, Yong-Chul (Department of Internal Medicine, Chonbuk National University Medical School, Chonbuk University) ;
- Rhee, Yang-Keun (Department of Internal Medicine, Chonbuk National University Medical School, Chonbuk University)
- 발행 : 1997.10.31
초록
연구배경 : 스테로이드제제는 기관지 천식 및 만성 폐쇄성 폐질환 환자치료에 매우 효과적으로 항염작용, 기관지내 과민반응 억제 및 기타 면역학적인 기전으로 작용한다. 그러나 부신피질 기능억제, 쿠싱 증후군, 골다공증 등의 전신적 부작용으로 인해 그 사용 범위가 제한되어 왔다. 1970년대 초반부터 고도의 국소적 작용을 갖는 흡입성 스테로이드제제가 천식 치료에 활발히 이용되고 있으나 이 약물 투여에 따른 기저 코티솔 농도에 미치는 영향에 대해서는 아직도 논란이 많다. 이에 저자들은 최근에 개발된 강력한 흡입성 스테로이드제제인 fluticasone propionate의 시상하부-뇌하수체-부 신축에 미치는 영향을 알아보고자 기관지천식과 만성 폐쇄성 폐질환 환자를 대상으로 하여, 단기간 투여용량에 따른 fluticasone propionate의 기저 코티솔 농도에 미치는 영향을 관찰하였다. 방 법 : 1993년 7월부터 1997 년 3월까지 전북대학교 병원 내과에 입원치료한 기관지 천식과 만성 폐쇄성 폐질환환자를 대상으로 하였다. 환자는 흡입성 fluticasone propionate 투여전 최소한 10일 동안 어떠한 종류의 스테로이드도 투여하지 않았고, 치료기간 12일 동안 하루에
Backgroung : The efficacy of oral corticosteroids in the treatment of chronic asthma is undisputed, but their long-term use is associated with adverse side-effects, including supression of the hypothalamic-pituitary adrenal axis function, osteoporosis, weight gain, hypertension and impaired glucose tolerance. The introduction of inhaled corticosteroids in the early 1970's represented a significant therapeutic advance in the management of asthma, since these compounds combined high topical potency with low systemic activity. Fluticasone propionate is a new topically active synthetic glucocorticosteroid that combinds a high degree of efficacy with negligible systemic bioavailability. This study was perfomed to determine the effect of inhaled fluticasone propionate on the adreocortical supression in patients with bronchial asthma or chronic obstructive pulmonary disease. Method : The adrenocortical function was assessed by measurement of plasma cortisol concentration at 8 o'clock in morning and free cortisol in 24 hour urine collection at interval. Absolutely, no steroid was taken during pretreatment period of 10days. There after each subject inhaled fluticasone aerosol, in daily doses of 500 or 1000micrograms for 12days. The dose was delivered by metered dose inhaler(MDI). Results : The serum cortisol and 24hour urinary free cortisol were not decreased during the treatment period in patients with inhaled fluticasone propionate in daily doses of 500 micrograms. In contrast, serum cortisol was significantly decreased on 9th and 12th day(p less than 0.05). And, 24hour urinary free cortisol was also significantly decreased on 3rd and 12th day of treatement period(p less than 0.05) in patients with inhaled fluticasone in daily doses of 1000 micrograms. Conclusion : These results suggested that endogenous cortisol secretion was not supressed after short-term inhalation of fluticasone in daily dose of 500 micrograms, but in daily dose of 1000 micrograms, the endogenous cortisol secretion was supressed.