運動員使用糖皮質類固醇對運動表現之影響

糖皮質類固醇（glucocorticoids, GC）具抗發炎作用，可用於治療氣喘及慢性肌肉骨骼損傷。自2004年世界運動禁藥管制組織（World Anti-Doping Agency, WADA）規定，禁止於賽內期間以口服、直腸、靜脈注射或肌肉注射方式使用GC。有人認為因臨床廣泛應用，運動員使用GC治療完全可接受，而且GC持續占已核准治療用途豁免權（therapeutic use exemption, TUE）的最大宗，應完全從WADA運動禁藥清單中移除；其他人確信因GC有引發運動員不利健康之風險，運動員應該避免賽內使用GC，也不能允許TUE。本文乃透過文獻回顧並整理WADA公布2013~2018年不利檢測分析結果案例數，目的在探討GC是否能增進運動表現？分析結果指出GC由2013年的6.3%降低至2016年的4.0%，陽性率排位由第4位降為第5位，僅次於同化性類固醇、胜肽類荷爾蒙、興奮劑、利尿劑類禁藥，顯示運動員或隊醫對使用GC情形可能漸不熱衷。較常使用的GC是budesonide, prednisone, prednisolone, betamethasone。此外，短期全身性使用GC並沒有增加表現。針對耐力運動及短期激烈運動時，GC是否能延緩「中樞疲勞」並影響人體動作驅動及隨意肌活動，短期給藥後數週對運動表現及代謝之影響也仍需進一步研究。考量多種副作用及違反禁藥的風險，我們希望日後運動員與醫師能更謹慎評估使用GC之必要性。

關鍵字

世界運動禁藥管制組織；治療用途豁免權；運動禁藥清單；不利檢測分析結果；耐力運動

並列摘要

The anti-inflammatory effects of glucocorticoids (GCs) make them the treatment of choice for asthma and painful chronic musculoskeletal injuries. However, the use of systemic GCs in sport remains a vexing issue. GCs have been prohibited in-competition since 2004 when administered by systemic (oral, rectal, intramuscular, or intravenous) routes. There are proponents who view GC treatment as perfectly acceptable for athletes if clinically indicated. Some further hold that GCs consistently make up the largest share of granted therapeutic use exemptions (TUEs) and should be removed entirely from prohibited substances list of the World Anti-Doping Agency (WADA). Others believe that athletes with either chronic or acute medical conditions should not be granted TUEs, but instead should be prevented from competing owing to the health risk. The purpose of this article is to review relevant literature and examine the statistics of adverse analytical finding (AAF) from WADA to explore whether GCs can enhance performance. The results show that the prevalence of GC use decreased over 4 years from 6.3% (2013) to 4.0% (2016). The ranking of AAF cases decreased from 4th to 5th. Budesonide, prednisone, prednisolone, and betamethasone were detected with high frequency. Athletes engaging in endurance exercises were seemingly prone to use GCs as a performance-enhancing substance. GCs have no performance-enhancing effects on short systemic-uses. Owing to the various adverse effects of GCs and the risk of violating rules, we suggest that athletes and physicians should use GCs carefully for therapeutic purposes.

並列關鍵字

World Anti-Doping Agency ； therapeutic use exemption ； prohibited substances list ； adverse analytical finding ； endurance exercis

參考文獻

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Arlettaz, A., Collomp, K., Portier, H., Lecoq, A.-M., Rieth, N., Le Panse, B., & De Ceaurriz, J. (2008). Effects of acute prednisolone administration on exercise endurance and metabolism. British Journal of Sports Medicine, 42(4), 250-254. doi:10.1136/bjsm.2007.039040

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Arlettaz, A., Portier, H., Lecoq, A.-M., Rieth, N., de Ceaurriz, J., & Collomp, K. (2007). Effects of short-term prednisolone intake during submaximal exercise. Medicine & Science in Sports & Exercise, 39(9), 1672-1678. doi:10.1249/mss.0b013e3180dc9 92c

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運動員使用糖皮質類固醇對運動表現之影響

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