Iwasaki T, Tamura G, Sano K, Ohkawara Y, Haneda K, Shirato K
First Department of Internal Medicine, Tohoku University School of Medicine.
Arerugi. 1999 Jun;48(6):632-8.
Although glucocorticoid is the most effective agent for bronchial asthma, its systemic administration leads to suppression of adrenocortical function. Rapid ACTH test has been performed for assessing the function of the hypothalamic-pituitary-adrenocortical (HPA) system of asthmatics. Recently human corticotropin-releasing hormone (CRH) has been chemically synthesized. In order to evaluate clinical usefulness of CRH, we compared CRH test with ACTH test in 17 patients with bronchial asthma (3 patients out of them concurrently receiving prednisolone 5-10 mg/day). Both tests were carried out within 2 weeks after 6 month treatment with fluticasone propionate (800 micrograms/day) inhaled via pMDI. There is no significant difference between results obtained from the both tests. Thus, dividing subjects into high and low responders based on an extent of increases in plasma ACTH levels after the CRH injection, we found a significant difference in maximal plasma concentrations of cortisol between after CRH and ACTH injections in the low responders. Therefore, in some patients, CRH test provides more accurate assessment of the function of HPA system than ACTH test.
尽管糖皮质激素是治疗支气管哮喘最有效的药物，但其全身给药会导致肾上腺皮质功能受到抑制。已进行快速促肾上腺皮质激素（ACTH）试验以评估哮喘患者下丘脑 - 垂体 - 肾上腺皮质（HPA）系统的功能。最近，人促肾上腺皮质激素释放激素（CRH）已被化学合成。为了评估CRH的临床实用性，我们在17例支气管哮喘患者（其中3例同时接受5 - 10毫克/天泼尼松龙治疗）中比较了CRH试验和ACTH试验。两项试验均在通过定量吸入器（pMDI）吸入丙酸氟替卡松（800微克/天）治疗6个月后的2周内进行。两项试验所得结果之间无显著差异。因此，根据CRH注射后血浆ACTH水平升高程度将受试者分为高反应者和低反应者，我们发现低反应者中CRH注射后和ACTH注射后皮质醇的最大血浆浓度存在显著差异。因此，在某些患者中，CRH试验比ACTH试验能更准确地评估HPA系统的功能。
