RU486 对正常人和库欣综合征患者垂体-肾上腺轴的影响及其临床应用

EFFECT OF RU486 ON PITUITARY ADRENAL AXIS RESPONSE IN NORMAL SUBJECTS AND PATIENTS WITH CUSHING'S SYNDROME AND ITS CLINICAL APPLICATION

本文观察了１０例正常人和１４例库欣综合征患者垂体肾上腺轴在单次口服ＲＵ４８６４ｍｇ／ｋｇ后的反应。正常人在８ｐｍ口服ＲＵ４８６后连续２天８Ａｍ的血促肾上腺皮质激素（ＡＣＴＨ）和皮质醇（Ｆ）均明显升高（Ｐ＜０．０１，Ｐ＜０．００１），服药后第一天２４ｈ尿Ｆ亦明显升高（Ｐ＜０．００１）。库欣综合征组服药后连续观察２天上述激素水平无明显改变。正常组服药后连续２天的血Ｆ，ＡＣＴＨ及２４ｈ尿Ｆ较服药前所增加的百分比均明显高于库欣综合征组（Ｐ＜０．０５）。正常人和库欣综合征患者的垂体肾上腺轴对ＲＵ４８６有明显不同的反应。我们认为一次法ＲＵ４８６激发试验诊断库欣综合征优于小剂量地塞米松抑制试验，可能有临床应用价值。

The pituitary adrenal axis response to a single dose of RU486 (4mg/kg) was observed in 10 normal subjects and 14 patients with Cushing's syndrone. It was found that after RU486 was given at 20:00, the 8Am levels of plasma ACTH and plasma cortisol were increased significantly (P<0.01,P<0.001) on the next two consecutive days and 24h urine cortisol was increased remarkably(P<0.01)on the next day. In Cushing's syndrome group, the administration of a single dose of RU486 induced no significant changes in the a forementioned hormone levels (P>0.05) on the next two consecutive days. In normal subjects, the increased perceatages of plasma contisol. ACTH and urine cortisol on the two consecutive days after taking RU486 were significantly higher than those in the Cushing's group(P<0.05). There was a significantly different response of pituitary adrenal axis to RU486 between normal subjects and Cushing's group. The results suggest that RU486 stimulating test may have clinical value in diagnosing Cushing's syndrome.