不同中效糖皮质激素对非频复发肾病血清皮质醇及ACTH的影响

The Effects of Lente Glucocorticoid on Serum Cortisol and ACTH in Patient with Non-Frequently Relapsing Nephrotic Syndrome

目的研究不同中效糖皮质激素(GC)对非频复发原发性肾病综合征(PNS)患儿血清皮质醇(COR)及促肾上腺皮质激素(ACTH)的影响。方法将60例非频复发PNS患儿随机分为泼尼松组(Ⅰ组)、曲安西龙组(Ⅱ组)及甲泼尼龙组(Ⅲ组),采用标准激素治疗方案,分别观察3组激素治疗前(A期)、诱导缓解期结束时(B期)、相当于泼尼松1mg·kg-1·d-1隔日时(C期)、相当于泼尼松0.25mg·kg-1·d-1隔日时(D期)及停用激素4周时(E期)血清COR及ACTH的变化。结果各组血清COR水平于B期差异有统计学意义(P<0.05);Ⅰ组B期、C期、D期与A期比较差异均有统计学意义(P<0.05或P<0.01);B期与D期比较差异有统计学意义(P<0.05);Ⅰ组E期与A期、Ⅱ组D期与A期、Ⅲ组C期与A期比较差异无统计学意义(P>0.05)。各组内血清ACTH水平B期与A期比较均有统计学意义(P<0.05);Ⅰ组和Ⅱ组于D期、Ⅲ组于C期血清ACTH水平均高于A期(P<0.05);Ⅰ组至E期仍高于A期,Ⅱ组、Ⅲ组于E期恢复至A期水平。结论曲安西龙对血清COR的影响最为明显,泼尼松影响最小、恢复最慢,甲泼尼龙恢复最快,但泼尼松对垂体功能的抑制作用较曲安西龙及甲泼尼龙持久。

Objective To study the effects of different types of glucocorticoid （GC） on the serum cortisol （COR） and adrenocorticotropic hormone （ACTH） in patients with non-frequently relapsing nephrotic syndrome （PNS）. Methods Sixty patients with non-frequent relapses PNS were randomly divided into prednisone group （ Ⅰ group）, triamcinolone group （ Ⅱ group） and methylprednisolone group （Ⅲ group）. Each of them was treated with standard glucocorticoid therapy. The serum levels of eortisol and ACTH were observed before treatment （A phase）, the end of remission phase （B phase）, the day after us- ing 1 rag. kg-~. d -1 prednisone （C phase）, the day after using 0.25 rag. kg-~. d -~ prednisone （D phase） and 4 weeks after the end of glucocorticoid therapy （E phase）. Results There were significant differences in the serum COR levels in the B phase be- tween three groups （P 〈 0.05）. There were also significant differences in the serum COR levels of I group between A phase and B phase, C phase and D phase （P〈 0.05 or P〈 0.01）, and there was significant difference between B phase and D phase （P 〈 0.05）. There were no significant differences in the serum COR levels between D phase and A phase of Ⅱ group, and be- tween C phase and A phase of Ⅲ group （P 〉 0.05）. There were significant differences in the serum ACTH levels between B e phase and A phase of three groups （P 〈 0.05）. The serum ACTH levels were higher in D phase than those in A phase of I group and Ⅱ group. The serum ACTH level was higher in C phase than that of A phase in Ⅲ group （P 〈 0.05）. The serum ACTH level was still higher in E phase than that of A phase in I group, but the level returned to A phase from E phase in Ⅱ group and Ⅲ group. Conclusion Triamcinolone is the most obvious impact on the serum COR level. Prednisone affects the smallest and is the slowest recovery. Methylprednisolone shows the fastest recovery. The inhibitory effect of prednisone on pi- tuitary function is longer than that of triamcinolone and methylprednisolone.