慢性再生障碍性贫血患者内分泌激素及其受体中医证型的分布特点

目的：观察慢性再生障碍性贫血（chronicaplasticanemia，CAA）肾阳虚和肾阴虚患者外周血单个核细胞的雄激素受体（androgenreceptor，AR）、糖皮质激素受体（glucocorticoidreceptor，GR）水平及相关内分泌激素与正常人群之间是否存在差异；并探讨CAA患者中医证型与上述指标的相关性。方法：（1）采用酶联免疫吸附试验（ELISA）检测CAA肾阳虚和肾阴虚患者治疗前AR和GR水平及肾阳虚患者治疗后3个月和6个月的AR和GR水平；（2）应用化学发光免疫法及放射免疫法检测CAA患者治疗前后外周血血浆中甲状腺激素类、性激素类及皮质醇、促肾上腺皮质激素等垂体-肾上腺轴激素水平。结果：（1）CAA肾阳虚和肾阴虚患者治疗前的AR、GR水平显著低于正常组（P〈0．01或P〈0．05）。CAA肾阳虚患者治疗前AR、GR表达水平显著低于肾阴虚患者（P〈0．05或P〈0．01）。肾阳虚患者治疗后3个月和6个月AR、GR表达水平均高于治疗前（P〈0．05）；（2）CAA患者FT3、FT4、睾酮水平较正常组均有下降（P〈0．01或P〈0．05），经治疗后，有明显上升趋势，统计学无差异（P〉0．05）；肾阳虚患者FT4、皮质醇、睾酮水平显著低于肾阴虚患者（P〈0．05）。结论：检测CAA患者外周血AR、GR表达水平及相关内分泌激素等水平可能成为中医证型的客观依据，有利于动态监测病情及指导临床治疗。

Characteristics of Endocrine Hormones and Their Receptors in Chronic Aplastic Anemia Patients with Different TCM Syndromes

Objective ： To observe the change of endocrine hormones and their receptors expression in peripheral blood mononuclear cells of patients with chronic aplastic anemia （CAA） of kidney yin deficiency or kidney yang deficiency,and to study the correlation of TCM syndromes in patients with CAA. Methods ： Enzyme - linked immunsorbent assay was used to investigate the level of endocrine hormones and their receptors in peripheral blood cell of patients with initially diagnosed CAA. CAA patients were grouped by kidney yin deficiency and kidney yang deficiency. Immunocytochemistry was used to evaluate the contents of thyroid hormones, sex hormones and pituitary - adrenal axis hormones, such as corticosteroid （ CS）, adrenocorticotropic hormone （ACTH） in plasma in the four groups. Result ： The contents of AR and GR were significantly lower than those of the control group（P 〈 0.01 or P 〈 0.05 ）. The levels of AR and GR in patients of kidney yang deficiency with initially diagnosed CAA were significantly lower than those of kidney yin deficiency （P 〈 0.05 or P 〈 0.01 ）. The levels of AR and GR in CAA patients of kidney yang deficiency treated for three months were on the rise（P 〈 0.05 ）. It was the same to this group treated for six months （ P 〈 0.05 ）. In addition, the contents of FT3, FT4 and testosterone were significantly lower than those of the control group （P 〈 0.01 or P 〈 0.05 ）, while those of kidney yin deficiency of CAA significantly were higher than those of kidney yang deficiency （ P 〈 0. 05 ）. Conclusion ： The level of endocrine hormone receptors reveals disease state and prognosis in the treatment of CAA. Corticosteroid,FT4 and testosterone may become objective indicators for TCM syndromes in patients with CAA.