不同类型脊髓损伤患者外周血白细胞糖皮质激素受体的比较及意义

The comparison and significance of the glucocorticoid receptors of the peripheral leukocytes in patients with acute spinal cord injury or with chronic spinal cord compression

目的比较急性脊髓损伤患者和慢性脊髓压迫症患者外周血白细胞糖皮质激素受体(glucocorticoidreceptor,GR)的结合位点数并探讨其意义。方法采用放射配体结合法测定20例急性脊髓损伤患者和21例慢性脊髓压迫症患者外周血白细胞上GR结合位点数。结果急性脊髓损伤患者外周血白细胞GR结合位点数为(2517±857.8)个/细胞,慢性脊髓压迫症患者为(4225±1271)个/细胞,经统计学比较两者差异有显著性意义。全瘫患者外周血白细胞GR结合位点数为(2279±921)个/细胞,不全瘫患者为(2806±718)个/细胞,两者比较差异无显著性意义。结论外周血白细胞上的GR有高亲和力和低亲和力两种结合位点,急性脊髓损伤后外周血白细胞的GR结合位点数的减少主要是高亲和力位点的减少,低亲和力位点维持不变。大剂量的糖皮质激素和白细胞的低亲和力位点结合,抑制白细胞的趋向移动,减少白细胞进入损伤脊髓区,减轻损伤后的急性炎症反应,起到保护神经作用。慢性脊髓压迫症患者给予糖皮质激素治疗无效。

Objective To investigate the difference and significance of the glucocorticoid receptors of the peripheral leukocytes in patients with acute spinal cord injury or with chronic spinal cord compression. Methods Glucocorticoid receptors binding sites on the peripheral leukocytes in 20 patients with acute spinal cord injury and 21 patients with chronic spinal cord compression were measured by the radioligand binding assay. Results Glucocorticoid receptors binding sites on peripheral leukocytes from the patients with acute spinal cord injury is 2 517±857.8 per cell, the patients with chronic spinal cord compression is 4 225±1 271 per cell and outcome is 2 279±921 per cell in the patients with complete paralysis, 2 806±718 per cell in the incomplete paralysis patients. T test was used to evaluate the final outcome. Conclusion Glucocorticoid receptors binding sites on the peripheral leukocytes consist of two kinds: the high affinity binding sites and the low affinity binding sites. The high affinity glucocorticoid receptors binding sites on peripheral leukocytes in patients with acute spinal cord injury decrease and low affinity binding sites remain unchanged. Large doses of glucocorticoid combine the low affinity binding sites on peripheral leukocytes which inhibits the tendency of movement of leukocytes to the injured spinal cord; so inflammatory reaction produced by acute injury can be alleviated and thus the spinal cord was protected. There is no curative effect by using large doses of glucocorticoid to treat patients with chronic spinal cord compression.