Härle P, Pongratz G, Weidler C, Büttner R, Schölmerich J, Straub R H
Laboratory of Neuro/endocrino/immunology, Department of Internal Medicine I, University Hospital Regensburg, D-93042 Regensburg, Germany.
Ann Rheum Dis. 2004 Jul;63(7):809-16. doi: 10.1136/ard.2003.011619.
Hypoandrogenicity is common in obesity and in chronic inflammatory diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Adrenal androgens such as androstenedione (ASD) and dehydroepiandrosterone (DHEA) sulphate are low, which partly depends on the influence of TNF in chronic inflammatory diseases. Leptin is stimulated by TNF and is associated with hypoandrogenicity in non-inflammatory conditions.
To study the interrelation between serum levels of leptin and adrenal steroids in SLE and RA.
In a retrospective study, serum levels of leptin, ASD, DHEA, and 17-hydroxyprogesterone (17OHP) were measured by ELISA, and serum levels of cortisol by radioimmunoassay in 30 patients with RA, 32 with SLE, and 54 healthy control subjects (HS).
In SLE and RA but not HS, serum levels of ASD correlated negatively with serum levels of leptin (p<0.01) independently of prior prednisolone treatment in patients with SLE (p = 0.013) and tended to be independent of prednisolone in patients with RA (p = 0.067). In a partial correlation analysis, this interrelation remained significant after controlling for daily prednisolone dose in both patient groups. In both patient groups, serum leptin levels correlated negatively with the molar ratio of serum ASD/serum cortisol and serum ASD/serum 17OHP, and positively with the molar ratio of serum DHEA/serum ASD.
The negative correlation of serum leptin and ASD or, particularly, ASD/17OHP, together with its known anti-androgenic effects indicate that leptin is also involved in hypoandrogenicity in patients with SLE and RA. Leptin may be an important link between chronic inflammation and the hypoandrogenic state.
雄激素缺乏在肥胖以及慢性炎症性疾病如系统性红斑狼疮（SLE）和类风湿关节炎（RA）中很常见。肾上腺雄激素如雄烯二酮（ASD）和硫酸脱氢表雄酮（DHEA）水平较低，这部分取决于肿瘤坏死因子（TNF）在慢性炎症性疾病中的影响。瘦素受TNF刺激，在非炎症状态下与雄激素缺乏有关。
研究SLE和RA患者血清瘦素水平与肾上腺类固醇之间的相互关系。
在一项回顾性研究中，采用酶联免疫吸附测定法（ELISA）检测了30例RA患者、32例SLE患者和54例健康对照者（HS）血清中的瘦素、ASD、DHEA和17-羟孕酮（17OHP）水平，采用放射免疫测定法检测血清皮质醇水平。
在SLE和RA患者而非HS中，ASD血清水平与瘦素血清水平呈负相关（p<0.01），在SLE患者中独立于先前的泼尼松龙治疗（p = 0.013），在RA患者中倾向于独立于泼尼松龙（p = 0.067）。在偏相关分析中，在两个患者组中控制每日泼尼松龙剂量后，这种相互关系仍然显著。在两个患者组中，血清瘦素水平与血清ASD/血清皮质醇和血清ASD/血清17OHP的摩尔比呈负相关，与血清DHEA/血清ASD的摩尔比呈正相关。
血清瘦素与ASD或特别是ASD/17OHP的负相关，以及其已知的抗雄激素作用表明，瘦素也参与SLE和RA患者的雄激素缺乏。瘦素可能是慢性炎症与雄激素缺乏状态之间的重要联系。
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