de Vries Laura V, de Jong Wilhelmina H A, Touw Daan J, Berger Stefan P, Navis Gerjan, Kema Ido P, Bakker Stephan J L
Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Laboratory Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Steroids. 2017 Nov;127:31-39. doi: 10.1016/j.steroids.2017.09.001. Epub 2017 Sep 8.
Chronic prednisolone treatment in renal transplant recipients (RTR) causes metabolic abnormalities, which cluster in the metabolic syndrome (MS). It also suppresses the hypothalamic-pituitaryadrenal (HPA)-axis. We investigated whether HPA-axis suppression, as measured by 24h urinary cortisol excretion, is associated with presence of the MS and its individual components, in outpatient RTR with a functioning graft for >1year. Urinary cortisol was measured in 24h urine, using LC-MS/MS (LOQ 0.30nmol/L). We included 563 RTR (age 51±12years; 54% male) at median 6.0 [IQR, 2.6-11.5] years post-transplantation. MS was present in 439/563 RTR (78%). Median 24h urinary cortisol excretion was 2.0 [IQR, 0.9-5.1]nmol/24h. Twenty-four hour urinary cortisol excretion was independently associated with MS presence (OR=0.80 [95% CI, 0.66-0.98], P=0.02). It was also independently associated with bodyweight (st.β=-0.11, P=0.007), waist circumference (st.β=-0.10, P=0.01), BMI (st.β=-0.14, P=0.001), fasting triglycerides (st.β=-0.15, P=0.001), diabetes (st.β=-0.12, P=0.005), and number of antihypertensives used (st.β=-0.13, P=0.003). Suppressed HPA-axis activity, as reflected by decreased 24h urinary cortisol excretion, is associated with higher prevalence of MS and its individual components (i.e. central obesity, dyslipidemia, diabetes, hypertension) in prednisolone-treated RTR. Assessment of 24h urinary cortisol excretion by LC-MS/MS may be a tool to monitor metabolic side-effects of prednisolone in RTR.
肾移植受者（RTR）长期接受泼尼松龙治疗会导致代谢异常，这些异常集中在代谢综合征（MS）中。它还会抑制下丘脑 - 垂体 - 肾上腺（HPA）轴。我们调查了在移植肾功能正常超过1年的门诊RTR中，通过24小时尿皮质醇排泄量衡量的HPA轴抑制是否与MS及其各个组分的存在相关。使用液相色谱 - 串联质谱法（LC - MS/MS，定量下限0.30nmol/L）测定24小时尿液中的皮质醇。我们纳入了563例RTR（年龄51±12岁；54%为男性），移植后中位时间为6.0[四分位间距，2.6 - 11.5]年。563例RTR中有439例（78%）存在MS。24小时尿皮质醇排泄量中位数为2.0[四分位间距，0.9 - 5.1]nmol/24小时。24小时尿皮质醇排泄量与MS的存在独立相关（比值比=0.80[95%置信区间，0.66 - 0.98]，P = 0.02）。它还与体重（标准β=-0.11，P = 0.007）、腰围（标准β=-0.10，P = 0.01）、体重指数（标准β=-0.14，P = 0.001）、空腹甘油三酯（标准β=-0.15，P = 0.001）、糖尿病（标准β=-0.12，P = 0.005）以及使用的抗高血压药物数量（标准β=-0.13，P = 0.003）独立相关。24小时尿皮质醇排泄量降低所反映的HPA轴活性受抑制，与泼尼松龙治疗的RTR中MS及其各个组分（即中心性肥胖、血脂异常、糖尿病、高血压）的较高患病率相关。通过LC - MS/MS评估24小时尿皮质醇排泄量可能是监测RTR中泼尼松龙代谢副作用的一种工具。
