糖皮质激素对晚期消化管肿瘤患者内源性皮质醇水平的影响

Effect of glucocorticoids on the level of endogenous cortisol in patients with advanced gastrointestinal cancer

目的:观察晚期消化管肿瘤患者体内血清皮质醇水平,以及外源性糖皮质激素治疗对患者恶性症状和血清皮质醇水平的影响。方法:31例晚期消化管肿瘤患者(其中食管贲门癌8例、胃癌12例、结直肠癌11例)接受每日40 mg甲强龙治疗,连续5 d;另选择30例健康成人作为对照。采用皮质醇放射免疫测定试剂盒测定晚期消化管肿瘤患者和健康成人的血清皮质醇水平,并观察患者的生活质量变化。结果:31例消化管恶性肿瘤患者血清皮质醇水平高于健康对照者,分别为(312.39±57.64)和(144.64±52.20)μg/L,差异有统计学意义(P<0.01)。食管贲门癌、胃癌和结直肠癌患者血清皮质醇水平均较健康对照组高,差异有统计学意义(P<0.05),其中尤以胃癌患者的血清皮质醇升高更为显著(P<0.01)。经外源性糖皮质激素治疗后,晚期消化管肿瘤患者的食欲、精神、睡眠、疲乏和疼痛这5项指标均有所改善,未发生严重并发症;血清皮质醇水平在外源性糖皮质激素治疗前后无显著变化(P>0.05)。结论:晚期消化管恶性肿瘤患者血清内源性皮质醇水平较正常健康成人升高,中等剂量短期糖皮质激素治疗对内源性血清皮质醇水平的影响不大。

Objective：To observe the level of endogenous cortisol in patients with advanced gastrointestinal cancer,and to evaluate the effect of exogenous glucocorticoids treatment on patient＇s malignant symptoms and serum cortisol level.Methods：Thirty-one patients with advanced gastrointestinal cancer who were given 40 mg/d methylprednisolone for continuous 5 days.The patients included 8 patients with esophageal and cardial cancer,12 patients with gastric cancer,and 11 patients with colorectal cancer.At the same time,30 healthy adults were selected as control group.The cortisol radioactive immunoassay kit was used to determine the level of serum cortisol in the gastrointestinal cancer patients and controls.The life quality changes of gastrointestinal cancer patients were evaluated.Results：The serum cortisol level of 31 advanced gastrointestinal cancer patients was higher than that of healthy volunteers [（312.39±57.64）vs（144.64±52.20） μg/L,P0.01].The average serum cortisol levels in the patients with esophageal cancer,gastric cancer and colorectal cancer were higher than healthy controls（P0.05）.The serum cortisol level in gastric cancer patients was the highest among the three types of gastrointestinal cancers（P0.01）.After being treated with exogenous glucocorticoids,the five parameters such as appetite,spirit,sleeping,fatigue and pain in gastrointestinal cancer patients were improved significantly.During the course of exogenous glucocorticoid treatment,there were no serious complications.The serum cortisol levels after exogenous glucocorticoid treatment did not change significantly in the patients with esophageal cancer,gastric cancer and colorectal cancer（P0.05）.Conclusion：Endogenous serum cortisol levels of gastrointestinal cancer patients were significantly higher than those of healthy adults.Short-term treatment with medium dosage of exogenous glucocorticoids had little effect on the endogenous serum cortisol level.