糖皮质激素对哮喘患者淋巴细胞亚群及其介质、内源性皮质醇的影响

Effect of glucocorticoid on lymphocyte subsets and the media,endogenous cortisol in asthma patients

目的探讨糖皮质激素等药物对哮喘患者淋巴细胞亚群及其介质、内源性皮质醇的影响,从而为临床合理使用药物提供依据。方法对144例急性发作期支气管哮喘患者,根据用药情况分为全身激素组、吸入激素组、气管扩张剂组。1、采用放射免疫分析法对白细胞介素-1(IL-1)、白细胞介素-6(IL-6)、肿瘤坏死因子α(TNF-α)、促肾上腺皮质激素(ACTH)、皮质醇(CS)及生长激素(GH)进行检测,2、采用酶联免疫法(ELISA)对促肾上腺皮质激素释放激素(CRH)进行检测,3、用流式细胞仪对淋巴细胞凋亡、CD3、CD4、CD8、CD11b、CD18及CD62P进行检测。应用SPSS12.0统计软件进行处理;计量资料用均数±标准差描述;多组均数比较用单因素方差分析。检验水准α=0.05。结果 CD4/CD8、CD11b/CD18、淋巴细胞凋亡、CS、ACTH、CRH在全身激素组与气管扩张剂组之间,吸入激素组与气管扩张剂组之间比较有差异。其他组之间比较无统计学差异。CD11b、CD62p在全身激素组与气管扩张剂组之间比较有差异。其他组之间比较无统计学差异。结论激素对哮喘患者免疫、内分泌有明显的影响。随着激素使用量的增加或全身使用,对淋巴细胞的免疫,有一定的抑制作用;并可能造成肾上腺皮质功能的减退。吸入激素对内源性皮质醇可能也有一定影响,尚需进一步探讨。

Objective To investigate the effects of glucocorticoid and other drugs on lymphocyte subsets and its media, endoge- nous cortisol in asthma patients,and thus provide the basis for reasonably using the drugs clinically. Methods According to the administration of medicines, 144 patients with acute exacerbation of bronchial asthma were divided into systemic corticosteroids（ group A）, inhaled corticosteroids （ Group B）, branchodilators （ group C ）. 1. Interleukin-1 （ IL-1 ）, interleukin 6 （ IL-6 ） and tumor necrosis factorα （ TNF-α ）, adrenocortiotropie hormone （ A CTH ）, cortisol （ CS ） and growth hormone （ GH ） were determined by RIA ; 2. Corticotropin-releasing hormone （CRH） was determined by enzyme-linked immunosorbent assay （ ELISA ） ; 3. Lymphocyte apoptosis, CD3, CD4, CD8, CD11 b, CD18 and CD62P were determined by flow cytometry. The results were analyzed by SPSS 12.0 statistical software;measurement data was analyzed by using mean ＋ standard deviation; several teams were analyzed by using single-factor analysis of variance. Test α = 0. 05 level. Results CD4/CD8, CD11 b/CD8, the lymphocyte apoptosis, CS, ACTH, CRH were different between the group A and group C, group B and group C;but there was no statistical difference among the other groups. CD11 b, CD62P were different between the group A and group C;but there was no statistical difference among the other groups. Conclusion The effect of glucocorticoid on asthma patients＇immune and endocrine is obvious. With the increased use of glucocorticoid or the systemic use, there is a certain degree of inhibition on the lymphocyte immune; and may result in decreased function of the adrenal cortex. Inhaled corticosteroid may also have some influence on endogenous cortisol, yet it still needs further exploring.