Kucera M, Topolcan O, Racek J, Panzner P
I. interní klinika FN, Plzen.
Vnitr Lek. 1995 Jul;41(7):449-53.
The authors tried to obtain information on levels of endogenous plasma cortisol in patients with rheumatoid arthritis and other diffuse connective tissue diseases, in particular systemic lupus erythematosus. Endogenous cortisol was assessed by radioimmunoanalysis at 8 a.m. and 4 p.m. If the sum of the morning and afternoon values reached the level of 280 nmol/l (sum of the lowest still normal values), they considered the daily cortisol secretion still normal. In a group of 30 patients who did not have glucocorticoid therapy the authors found only in one patient a lower daily endogenous cortisol secretion. In 117 patients with a relatively severe course of rheumatoid arthritis where small doses of corticoids (equivalents of 5-10 mg Prednisone) were administered for prolonged periods, a reduced daily secretion of endogenous plasma cortisol was recorded in almost 40%. Repeated examinations made in 13 subjects with rheumatoid arthritis revealed relatively frequent differences in values of endogenous plasma cortisol. In rare instances extremely low plasma levels of endogenous cortisol were found. Similar results as in rheumatoid arthritis, although assessed in a relatively small number of probands, were obtained by the authors also in patients with other diffuse connective tissue diseases, in particular those with systemic lupus erythematosus. Those patients had for prolonged periods roughly double doses of corticoids as compared with patients with rheumatoid arthritis. During repeated examinations the endogenous plasma cortisol levels varied also. The authors are aware that from the assembled results it is so far not possible to draw any definite conclusions and that further investigations are needed which will test the impact of endogenously produced corticoid.
作者试图获取类风湿关节炎及其他弥漫性结缔组织病患者，尤其是系统性红斑狼疮患者的内源性血浆皮质醇水平信息。通过放射免疫分析在上午8点和下午4点对内源性皮质醇进行评估。如果上午和下午的值之和达到280 nmol/l（仍为正常的最低值之和），他们认为每日皮质醇分泌仍属正常。在一组未接受糖皮质激素治疗的30名患者中，作者仅发现1例患者的每日内源性皮质醇分泌较低。在117例类风湿关节炎病情相对严重且长期服用小剂量皮质类固醇（相当于5 - 10 mg泼尼松）的患者中，近40%的患者记录到内源性血浆皮质醇每日分泌减少。对13名类风湿关节炎患者进行的重复检查显示，内源性血浆皮质醇值存在较为频繁的差异。在极少数情况下，发现内源性皮质醇的血浆水平极低。作者在其他弥漫性结缔组织病患者，尤其是系统性红斑狼疮患者中也获得了与类风湿关节炎患者类似的结果，尽管所评估的样本数量相对较少。与类风湿关节炎患者相比，这些患者长期服用的皮质类固醇剂量大致翻倍。在重复检查期间，内源性血浆皮质醇水平也有所变化。作者意识到，从目前汇总的结果来看，尚无法得出任何明确结论，需要进一步开展研究来检验内源性产生的皮质类固醇的影响。
