CAJ | 학술논문

目的：观察多发性硬化（multiple sclerosis ，MS）患者下丘脑‐垂体‐肾上腺轴（hypothalamo‐pituitary‐adrenal axis ，HPAA）的功能改变情况。方法选择作者医院60例非急性发作期MS患者（MS组），以同期作者医院门诊健康体检者30名为健康对照（对照组），采用酶联免疫吸附法（enzyme linked immunoassay ，ELISA ）检测早晨8点空腹血皮质醇（cortisol ，CORT ）、促肾上腺皮质醇激素（adrenocorticotropin ，ACT H ）、促肾上腺皮质醇激素释放激素（corticotropin releasing hormone ，CRH）水平。MS组患者根据EDSS评分的不同，分为EDSS＞4.5组（10例）和EDSS≤4.5组（50例）两组；根据 MS分型，分为复发缓解型 MS （relapsing‐remitting multiple sclerosis ，RRMS）组（48例）和非复发缓解型MS（非RRMS）组（12例）两组。结果与对照组〔（55.67±32.48） ng/mL〕比较，MS组CORT 〔（121.09±89.46） ng/mL〕表达升高（P＝0.000），与对照组〔（252.91±129.76） pg/mL〕比较，MS组ACTH〔（158.66±92.94） pg/mL〕表达下降（P＝0.024）。不同性别之间上述指标比较差异无统计学意义（均 P＞0.05）。EDSS评分＞4.5组〔（75.74±36.69） pg/mL ，（159.37±27.99） pg/mL〕较EDSS≤4.5组〔（175.07±92.97） pg/mL ，（217.11±65.34） pg/mL〕患者血清ACTH、CRH水平显著降低（P＝0.001，P＝0.032）。非RRMS组患者血清 ACTH、CRH 水平〔（101.62±57.02） pg/mL ，（174.89±52.48） pg/mL〕与RRMS组〔（172.68±96.11） pg/mL ，（215.61±64.89） pg/mL〕比较均显著下降（P＝0.008，P＝0.032）。结论MS 患者存在HPAA 的功能紊乱。
목적：관찰다발성경화（multiple sclerosis ，MS）환자하구뇌‐수체‐신상선축（hypothalamo‐pituitary‐adrenal axis ，HPAA）적공능개변정황。방법선택작자의원60례비급성발작기MS환자（MS조），이동기작자의원문진건강체검자30명위건강대조（대조조），채용매련면역흡부법（enzyme linked immunoassay ，ELISA ）검측조신8점공복혈피질순（cortisol ，CORT ）、촉신상선피질순격소（adrenocorticotropin ，ACT H ）、촉신상선피질순격소석방격소（corticotropin releasing hormone ，CRH）수평。MS조환자근거EDSS평분적불동，분위EDSS＞4.5조（10례）화EDSS≤4.5조（50례）량조；근거 MS분형，분위복발완해형 MS （relapsing‐remitting multiple sclerosis ，RRMS）조（48례）화비복발완해형MS（비RRMS）조（12례）량조。결과여대조조〔（55.67±32.48） ng/mL〕비교，MS조CORT 〔（121.09±89.46） ng/mL〕표체승고（P＝0.000），여대조조〔（252.91±129.76） pg/mL〕비교，MS조ACTH〔（158.66±92.94） pg/mL〕표체하강（P＝0.024）。불동성별지간상술지표비교차이무통계학의의（균 P＞0.05）。EDSS평분＞4.5조〔（75.74±36.69） pg/mL ，（159.37±27.99） pg/mL〕교EDSS≤4.5조〔（175.07±92.97） pg/mL ，（217.11±65.34） pg/mL〕환자혈청ACTH、CRH수평현저강저（P＝0.001，P＝0.032）。비RRMS조환자혈청 ACTH、CRH 수평〔（101.62±57.02） pg/mL ，（174.89±52.48） pg/mL〕여RRMS조〔（172.68±96.11） pg/mL ，（215.61±64.89） pg/mL〕비교균현저하강（P＝0.008，P＝0.032）。결론MS 환자존재HPAA 적공능문란。
Objective To observe changes of the function of hypothalamo‐pituitary‐adrenal axis (HPAA) of patients suffering from multiple sclerosis (MS) ,and the differences of HPAA function among different genders ,MS types .Methods Sixty MS patients during remission (the MS group) were included . Adrenocorticotropin (ACTH),corticotropin releasing hormone (CRH),total cortisol (CORT) in serum at 8∶00 am were measured by enzyme‐linked immunosorbent assay (ELISA) .The control group consisted of 30 healthy volunteers .According to different EDSS scores ,MS patients were divided into EDSS > 4.5 group (10 cases) and EDSS ≤4.5 group (50 cases) .According to MS type ,they were divided into relapsing‐remitting MS (RRMS) group (48 cases) and non‐relapsing‐remitting MS (non‐RRMS) group (12 cases) .Results Serum level of CORT [ (121.09 ± 89.46) ng/mL ,P=0.000] was significantly higher and ACTH [ (158.66 ± 92.94) pg/mL ,P=0.024] was lower comparing with those of the control group [ (55.67 ± 32.48) ng/mL ,(252.91 ± 129.76) pg/mL ,respectively ] .Differences were not found between those of different genders in MS patients . Serum levels of ACT H and CRH in the EDSS high group (EDSS>4.5) [ (75.74 ± 36.69) pg/mL , (159.37 ± 27.99) pg/mL] were significantly lower than those in the EDSS low group ( EDSS≤4.5) [ (175.07 ± 92.97) pg/mL , (217.11 ± 65.34) pg/mL] (P=0.001 , P=0.032) .Meanwhile , RRMS patients [ (172.68 ± 96.11) pg/mL , (215.61 ± 64.89 ) pg/mL ] presented significantly higher levels of ACT H and CRH in the serum comparing with the non‐RRMS patients [ (101.62 ± 57.02) pg/mL , (174.89 ± 52.48) pg/mL] (P=0.008 , P =0.032) .Conclusions The HPAA functions were abnormal in MS patients ,which played an important role in MS pathology .ACTH and CRH presented significantly lower levels in severer (EDSS> 4.5) and non‐RRMS patients .