不同类型脊髓损伤患者和正常成人外周血白细胞糖皮质激素受体的比较及意义

Glucocorticoid receptors of peripheral leukocytes in healthy adults patients with acute spinal cord injury and patients with chronic spinal cord compression

目的 比较正常成人和急性脊髓损伤患者、慢性脊髓压迫症患者外周血白细胞塘皮质激素受体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15例正常成人、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糖皮质激素受体结合位点数。结果 正常成人外周血白细胞精皮质激素受体结合位点数为4462±891.6个/细胞,慢性脊髓压迫症患者为4225±1271个/细胞,急性脊髓损伤患者为2517±857.8个/细胞,经统计学比较正常成人组和慢性脊髓压迫症患者组没有显著性差异,急性脊髓损伤组与其他两者相差均有显著性意义。急性脊髓损伤组中,全瘫患者为2279±921个/细胞,不全瘫患者为2806±718个/细胞,两者无统计学差异。结论 外周血白细胞上的糖皮质激素受体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精皮质激素受体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直,起到神经保护作用。慢性脊髓压迫症患者予以糖皮质激素治疗无疗效。

Objective To study the difference and significance of glueocorticoid receptors of peripheral leukocytes in healthy adults, patients with acute spinal cord injury, and patients with chronic spinal cord compression. Methods Glueocorticoid receptors binding sites of peripheral leukocytes of 15 healthy adults, 20 patients with acute spinal cord injury and 21 patients with chronic spinal cord compression were measured by radioligand binding assay. Results Glueocorticoid receptors binding sites of peripheral leukocytes in patients with acute spinal cord injury is 2517 ±857.8 per cell, 4225 ±1271 per cell in chronic spinal cord compression patients, 2279 ±921 per cell in complete paralysis patients, 2806 ± 718 per cell in incomplete paralysis patients, 4462 ± 891.6 per cell in healthy adults. T-test was used to evaluate the final outcome. Conclusion Glueocorticoid receptors binding sites in peripheral leukocytes consist of two types: high affinity binding sites and low affinity binding sites. High affinity glueocorticoid receptors binding sites of peripheral leukocytes in patients with acute spinal cord injury-decrease and low affinity binding sites remain unchangeable. Large doses of glueocorticoid combine the low affinity binding sites on the surface of peripheral leukocytes which inhibit the tendency move of leukocyte to injured spinal cord. So inflammatory reaction produced by acute injury alleviate, and then spinal cord can be protected. There is no curative effect for large doses of glueocorticoid to treat patients with chronic spinal cord compression.