三步序贯法对激素依赖型哮喘患者下丘脑-垂体-肾上腺皮质轴功能及糖皮质激素受体的影响  

Effect of three-stage sequential therapy on the functions of hypothalamic-pituitary-adrenal axis and levels of the glucocorticoid receptor in patients with steroid-dependent asthma

作　　者：崔红生[1] 徐光勋[2] 王硕仁[1] 周冠芬[1] 

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]首都医科大学附属北京中医医院,北京100010

出　　处：《中华中医药杂志》2008年第11期961-964,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金资助项目(No.30371714)

摘　　要：目的:观察三步序贯法对激素依赖型哮喘患者下丘脑-垂体-肾上腺皮质(hypothalamic-pituitary-adrenal,HPA)轴功能及糖皮质激素受体(glucocorticoid receptor,GCR)的影响。方法:将入选病例按随机数字表分为治疗组29例和对照组26例。在逐渐撤减泼尼松量的过程中,对照组予普米克都保(布地奈德粉吸入剂,100μg/吸),每次400μg,每日2次吸入;治疗组予中药三步序贯方煎剂,每次100ml,每日2次口服,同时给予普米克都保200μg,每日2次吸入。两组疗程均12-14周。观察治疗前后血浆皮质醇(cortisol,COR),促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)以及外周血单个核细胞(Peripheral blood mononuclear cell,PBMC)GCR数目的变化。结果:两组患者血浆ACTH和COR浓度以及PBMC GCR水平较治疗前均明显升高,且两组之间比较差异均具有显著性(P均<0.05)。结论:三步序贯法能够恢复SDA患者被抑制的HPA轴功能,上调PBMC GCR水平,从而具有减轻全身性不良反应,增强糖皮质激素的敏感性,减轻激素依赖的作用。Objective：To observe the effect of three-stage sequential therapy on the functions of hypothalamic-pituitary- adrenal（HPA） axis and levels of the glucocorticoid receptor in patients with steroid-dependent asthma. Methods： 55 patients with SDA were divided randomly into two groups,29 patients were treated with three-stage sequential recipes plus Pulmicort Turbuhaler（400μg/d） in the treatment group, while the other 26 patients with Pulmicort Turbuhaler （800μg/d） in the control group. The therapeutic courses were both 12-14 weeks. The plasma concentrations of ACTH and COR and the levels of PBMC GCR were determined before and after treatment. Results：The plasma concentrations of ACTH and COR and the levels of PBMC GCR in the two groups were all increased remarkably and there were significant difference between the two groups after treatment（P 〈 0.05）.Conclusions： Three-stage sequential therapy could recover the functions of HPA axis of the patients with SDA, upgrade the levels of GCR, and therefore could alleviate the side effects of steroid, improve its sensitivity and reduce the patients＇ dependence on it.

关 键 词：激素依赖型哮喘 三步序贯法 HPA轴 糖皮质激素受体 

分 类 号：R259[医药卫生—中西医结合]