Vogl Daniela, Falk Werner, Dorner Monika, Schölmerich Jürgen, Straub Rainer H
Department of Internal Medicine I, Laboratory of Neuroendocrinoimmunology, University Medical Center Regensburg, Regensberg, Germany.
J Rheumatol. 2003 Feb;30(2):269-75.
In patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), low levels of adrenal steroids have been repeatedly demonstrated, but the site of alteration has not been exactly described because measurements of serum pregnenolone and 17-hydroxypregnenolone (17OHPreg) together with other adrenal steroids have never been performed.
We measured serum levels of adrenal hormones such as pregnenolone, 17OHPreg, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS), progesterone (P), 17-hydroxyprogesterone (17OHP), androstenedione (ASD), and cortisol in 24 healthy controls, 24 patients with RA, and 24 patients with SLE.
Serum levels of pregnenolone were similar in RA and SLE patients as compared to healthy controls irrespective of prior prednisolone therapy. In all RA and SLE patients (including those with prior prednisolone treatment), serum levels of all measured hormones except pregnenolone were significantly lower as compared to controls. In RA patients without prior prednisolone treatment, serum levels of 17OHPreg, DHEA, cortisol, and ASD were similar to controls, and serum levels of P, 17OHP, and DHEAS were significantly lower as compared to controls. In SLE patients without prior prednisolone treatment, serum levels of 17OHPreg and cortisol were similar, and serum levels of P, 17OHP, ASD, DHEA, and DHEAS were significantly lower as compared to controls.
The primary hormone of the adrenal steroid cascade, pregnenolone, is almost normal in RA and SLE irrespective of corticosteroid treatment. In patients with RA, we believe that there is a near normal P450scc reaction and a normal double step P450c17 reaction. In SLE patients, the P450scc reaction also seems normal but the second step of the P450c17 reaction seems to be inhibited. In both diseases, cortisol levels remain relatively stable at the expense of other adrenal hormones. This study revealed distinct changes of steroid pathways that are related to the disease entities.
在类风湿关节炎（RA）和系统性红斑狼疮（SLE）患者中，肾上腺类固醇水平反复被证明较低，但由于从未同时测量血清孕烯醇酮和17 - 羟孕烯醇酮（17OHPreg）以及其他肾上腺类固醇，所以改变的部位尚未得到确切描述。
我们测量了24名健康对照者、24名RA患者和24名SLE患者血清中的肾上腺激素水平，如孕烯醇酮、17OHPreg、脱氢表雄酮（DHEA）、硫酸脱氢表雄酮（DHEAS）、孕酮（P）、17 - 羟孕酮（17OHP）、雄烯二酮（ASD）和皮质醇。
无论之前是否接受过泼尼松龙治疗，RA和SLE患者的血清孕烯醇酮水平与健康对照者相似。在所有RA和SLE患者（包括之前接受过泼尼松龙治疗的患者）中，除孕烯醇酮外，所有测量激素的血清水平均显著低于对照者。在未接受过泼尼松龙治疗的RA患者中，17OHPreg、DHEA、皮质醇和ASD的血清水平与对照者相似，而P、17OHP和DHEAS的血清水平显著低于对照者。在未接受过泼尼松龙治疗的SLE患者中，17OHPreg和皮质醇的血清水平相似，而P、17OHP、ASD、DHEA和DHEAS的血清水平显著低于对照者。
无论是否接受皮质类固醇治疗，肾上腺类固醇级联反应的主要激素孕烯醇酮在RA和SLE中几乎正常。在RA患者中，我们认为存在近乎正常的P450scc反应和正常的双步P450c17反应。在SLE患者中，P450scc反应似乎也正常，但P450c17反应的第二步似乎受到抑制。在这两种疾病中，皮质醇水平以牺牲其他肾上腺激素为代价保持相对稳定。本研究揭示了与疾病实体相关的类固醇途径的明显变化。
