Villette J M, Bourin P, Doinel C, Mansour I, Fiet J, Boudou P, Dreux C, Roue R, Debord M, Levi F
Unité d'Hormonologie, Laboratoire de Biochimie, Hôpital Saint-Louis, Paris, France.
J Clin Endocrinol Metab. 1990 Mar;70(3):572-7. doi: 10.1210/jcem-70-3-572.
Alterations in the circadian time structure of the secretion of several hormones were investigated in 13 male patients infected with human immunodeficiency virus (HIV). Seven were asymptomatic (classified CDC II, according to the criteria of the Atlanta Centers for Disease Control), and 6 had acquired immunodeficiency syndrome (CDC IV). Ten healthy males volunteered as controls. Plasma levels of dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S), cortisol, testosterone, ACTH, and beta-endorphin were determined by RIA in blood samples obtained every 4 h from 0830-0830 h the next morning. Data were analyzed both by two-way analysis of variance and the cosinor method. Circadian rhythms were statistically validated for each of the six hormones in each of the three groups of subjects. Compared with the control subjects, mesors (24-h adjusted means) were significantly higher for cortisol and lower for DHEA, DHEA-S, and ACTH (P less than 0.001 for all four hormones) in all HIV-infected patients. Plasma testosterone mesors were similar in controls and CDC II patients, but decreased significantly in the CDC IV patient group (P less than 0.05). Analysis of the circadian rhythms of plasma hormone levels clearly indicated an altered adrenal hormonal state in HIV-infected male patients, even during the asymptomatic period of the infection. For instance, plasma cortisol at 0430 h was more than twice as high in HIV-infected patients as it was in time-qualified controls. Although patients already had elevated plasma cortisol and lowered adrenal androgen levels at this stage, hypogonadism was not observed, as gauged by plasma testosterone concentrations. We speculate that the primary hormonal defect in HIV-infected patients is increased cortisol secretion resulting from circadian-varying stimulation of the adrenal cortex by a factor other than pituitary ACTH. This factor might be a stimulating substance secreted primarily by infected immune cells. Excess cortisol would lower adrenal androgen secretion by shifting adrenal steroid biosynthesis toward glucocorticoids and decreasing pituitary ACTH secretion via a negative feedback mechanism.
对13名感染人类免疫缺陷病毒（HIV）的男性患者体内几种激素分泌的昼夜时间结构变化进行了研究。其中7名无症状（根据亚特兰大疾病控制中心的标准分类为CDC II级），6名患有获得性免疫缺陷综合征（CDC IV级）。10名健康男性自愿作为对照。通过放射免疫分析法（RIA）测定从上午08:30至次日上午08:30每隔4小时采集的血样中脱氢表雄酮（DHEA）及其硫酸盐（DHEA-S）、皮质醇、睾酮、促肾上腺皮质激素（ACTH）和β-内啡肽的血浆水平。数据通过双向方差分析和余弦法进行分析。对三组受试者中每种六种激素的昼夜节律进行了统计学验证。与对照受试者相比，所有HIV感染患者的皮质醇中值（24小时校正均值）显著更高，而DHEA、DHEA-S和ACTH的中值更低（所有四种激素的P均小于0.001）。血浆睾酮中值在对照组和CDC II级患者中相似，但在CDC IV级患者组中显著降低（P小于0.05）。血浆激素水平昼夜节律分析清楚地表明，即使在感染的无症状期，HIV感染男性患者的肾上腺激素状态也发生了改变。例如，HIV感染患者在凌晨04:30时的血浆皮质醇比时间匹配的对照组高出两倍多。尽管患者在这个阶段已经出现血浆皮质醇升高和肾上腺雄激素水平降低，但根据血浆睾酮浓度判断，并未观察到性腺功能减退。我们推测，HIV感染患者的主要激素缺陷是由于除垂体ACTH以外的因素对肾上腺皮质的昼夜变化刺激导致皮质醇分泌增加。这个因素可能是主要由感染的免疫细胞分泌的一种刺激物质。过量的皮质醇会通过将肾上腺类固醇生物合成转向糖皮质激素并通过负反馈机制减少垂体ACTH分泌来降低肾上腺雄激素分泌。
