Leung D Y, Spahn J D, Szefler S J
Division of Allergy and Immunology, National Jewish Medical and Research Center, Denver, Colorado 80206, USA.
Allergy Asthma Proc. 1999 Jan-Feb;20(1):9-14. doi: 10.2500/108854199778681512.
Although the majority of patients with asthma respond favorably to inhaled and systemic glucocorticoids, up to 25% of patients with difficult-to-control asthma have poor clinical responses to high doses of systemic glucocorticoids. Early identification of these patients is required to minimize serious side effects from long-term systemic glucocorticoid therapy in patients who are insensitive to such therapy. Recent studies indicate that these individuals have developed diminished glucocorticoid receptor ligand and DNA binding affinity as the result of poorly controlled immune activation potentially triggered by allergens or infection. The current review will examine the immune mechanisms underlying glucocorticoid resistance and discuss the management of this challenging group of patients.
尽管大多数哮喘患者对吸入性和全身性糖皮质激素反应良好，但高达25%的难治性哮喘患者对高剂量全身性糖皮质激素的临床反应不佳。需要尽早识别这些患者，以尽量减少对这种治疗不敏感的患者长期接受全身性糖皮质激素治疗所产生的严重副作用。最近的研究表明，由于过敏原或感染可能引发的免疫激活控制不佳，这些个体的糖皮质激素受体配体和DNA结合亲和力有所下降。本综述将探讨糖皮质激素抵抗的免疫机制，并讨论这类具有挑战性的患者的管理。
