特发性视网膜血管炎中的垂体-肾上腺轴
The pituitary-adrenal axis in idiopathic retinal vasculitis.
作者信息
Palmer H E, Stanford M R, Lowy C, Wheeler M J, Wallace G R, Graham E M
机构信息
Medical Eye Unit, St Thomas's Hospital, London.
出版信息
Br J Ophthalmol. 1999 Dec;83(12):1393-5. doi: 10.1136/bjo.83.12.1393.
AIMS
To determine whether patients with idiopathic retinal vasculitis have altered production of cortisol and dehydroepiandrosterone sulphate (DHEA-S), and whether differences in these variables occur between those who are sensitive (SS) and resistant (SR) to steroids.
METHODS
20 patients with retinal vasculitis (off treatment) and 10 control subjects were prospectively recruited. Morning cortisol and DHEA-S levels were measured, and cortisol secretion rates and short synacthen tests (SST) carried out in patients before treatment, when on prednisolone 20 mg/day, and in controls.
RESULTS
There were no differences in any variables between patients and controls. For retinal vasculitis patients pretreatment, the SST was lower in SR patients (p=0.02). More of the SR patients had ischaemic retinal vasculitis ( p<0.001).
CONCLUSIONS
Cortisol and DHEA-S are not involved in the pathogenesis of retinal vasculitis. SR in retinal vasculitis may be associated with a defective hypothalamic-pituitary-adrenal axis.
目的
确定特发性视网膜血管炎患者的皮质醇和硫酸脱氢表雄酮（DHEA-S）分泌是否改变，以及这些变量在对类固醇敏感（SS）和耐药（SR）的患者之间是否存在差异。
方法
前瞻性招募了20例视网膜血管炎患者（未接受治疗）和10例对照受试者。测量了早晨的皮质醇和DHEA-S水平，并在治疗前、服用泼尼松龙20mg/天时的患者以及对照中进行了皮质醇分泌率和短程促肾上腺皮质激素试验（SST）。
结果
患者与对照之间的任何变量均无差异。对于视网膜血管炎患者，治疗前SR患者的SST较低（p = 0.02）。更多的SR患者患有缺血性视网膜血管炎（p < 0.001）。
结论
皮质醇和DHEA-S不参与视网膜血管炎的发病机制。视网膜血管炎中的SR可能与下丘脑-垂体-肾上腺轴功能缺陷有关。
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