SLE患者ACTH的变化及不同剂型糖皮质激素治疗对其的影响

目的初步探讨促肾上腺皮质激素(ACTH)与系统性红斑狼疮(SLE)发病的关系,以及不同剂型的糖皮质激素治疗(GC)对SLE患者ACTH的抑制情况。方法初发SLE患者52例,随机分成两组:地塞米松组和甲泼尼龙组,另收集20例健康体检者作对照。比较治疗前后ACTH水平,并分析ACTH与SLE临床及实验室指标的相关性。结果治疗前SLE组ACTH水平显著高于对照组(P<0.05),其中轻中度活动组水平显著高于对照组(P<0.05)。ACTH与白细胞计数及免疫球蛋白G呈正相关(P<0.05),与抗SSB抗体的阳性率呈负相关(P<0.05)。地塞米松组与甲泼尼龙组治疗前后的ACTH水平差异无统计学意义。结论 SLE患者存在ACTH的应答异常,并与病情活动相关,ACTH可能参与了SLE的发病。与甲泼尼龙治疗相比,短期使用大剂量地塞米松治疗初发SLE对ACTH水平影响差异无显著性。

Analysis of the variation of SLE patients’ACTH and the inhibition of GC on ACTH

Objective To investigate the relevance of adrenocorticotro-pichormone(ACTH) and the pathogenesis of SLE,and the inhibition of glucocorticoid(GC) on SLE patients’ACTH.Methods 52 cases recent onset SLE patients were divided randomly into two groups,who were treated respectively with dexamethasone and methylprednisolone in the early stage.And their ACTH indices were compared before and after the treatment and analyzed in terms of their relevance to the clinical and laboratory indices of SLE.Results The findings indicated that the indices of SLE group(especially mild and moderate active SLE patients) were significantly higher than those of the control group before treatment(P < 0.05),and there was a positive correlation between ACTH and WBC count and IgG(P < 0.05) and a negative correlation between ACTH and the positive rate of anti-SSB(P < 0.05).There was no statistically significant difference in the indices of ACTH between the group treated with dexamethasone and that treated with methylprednisolone.Conclusion The abnormal responses of SLE Patients’ACTH are closely related to the onset of SLE,and ACTH may be one of pathogenic factors.There is no significant difference in recent onset SLE patients whose ACTH treated with a massive dosage of dexamethasone or methylprednisolone.