Cutolo M, Foppiani L, Prete C, Ballarino P, Sulli A, Villaggio B, Seriolo B, Giusti M, Accardo S
Department of Internal Medicine, University of Genova, Italy.
J Rheumatol. 1999 Feb;26(2):282-8.
To assess hypothalamic-pituitary-adrenocortical axis function in patients with rheumatoid arthritis (RA) not previously treated with glucocorticoids in relation to their inflammatory condition and in comparison to healthy controls.
We evaluated, in 10 premenopausal patients with RA and 7 age matched controls, plasma dehydroepiandrosterone (DHEA), its sulfate (DHEAS), and cortisol concentrations, together with inflammatory cytokine levels [interleukin 6 (IL-6) and IL-12], both in basal conditions and after stimulation with ovine corticotropin releasing hormone (oCRH) and with low dose intravenous (5 microg) adrenocorticotropic hormone (ACTH).
DHEA and DHEAS basal concentrations were found to be significantly lower (p<0.05) in premenopausal patients with RA than in controls. As expected, significantly higher basal levels of IL-6 and IL-12 (p<0.05) were found in patients with RA. After the low dose ACTH testing, the DHEA area under the curve value was found to be significantly lower (p<0.01) in patients than controls. Similar results, but without statistical significance, were observed after oCRH stimulation. DHEA levels at basal time showed a significant negative correlation with the erythrocyte sedimentation rate and platelet count, as well as with the Steinbrocker class of the disease (p<0.05). Normal plasma cortisol levels during oCRH and ACTH testing were found in patients with RA in spite of their inflammatory condition. After ACTH testing, IL-6 levels decreased significantly (p<0.05), whereas IL-12 levels were unchanged. No significant changes in IL-6 and IL-12 levels were found after oCRH testing.
The abnormal androgen concentrations observed during testing in patients with RA might support the implication of adrenal androgens in the immune/inflammatory cytokine mediated mechanisms involved in the pathophysiology and clinical aspects of RA.
评估既往未接受糖皮质激素治疗的类风湿关节炎（RA）患者的下丘脑-垂体-肾上腺皮质轴功能，探讨其与炎症状态的关系，并与健康对照进行比较。
我们评估了10例绝经前RA患者和7例年龄匹配的对照者，检测其基础状态下以及经羊促肾上腺皮质激素释放激素（oCRH）和低剂量静脉注射（5微克）促肾上腺皮质激素（ACTH）刺激后的血浆脱氢表雄酮（DHEA）、其硫酸盐（DHEAS）和皮质醇浓度，以及炎症细胞因子水平[白细胞介素6（IL-6）和IL-12]。
绝经前RA患者的DHEA和DHEAS基础浓度显著低于对照组（p<0.05）。正如预期的那样，RA患者的IL-6和IL-12基础水平显著更高（p<0.05）。低剂量ACTH检测后，患者的DHEA曲线下面积值显著低于对照组（p<0.01）。oCRH刺激后观察到类似结果，但无统计学意义。基础时的DHEA水平与红细胞沉降率、血小板计数以及疾病的Steinbrocker分级显著负相关（p<0.05）。尽管RA患者存在炎症状态，但在oCRH和ACTH检测期间血浆皮质醇水平正常。ACTH检测后，IL-6水平显著下降（p<0.05），而IL-12水平未改变。oCRH检测后IL-6和IL-12水平无显著变化。
RA患者检测期间观察到的雄激素浓度异常可能支持肾上腺雄激素参与RA病理生理和临床方面的免疫/炎症细胞因子介导机制。
