哮喘和COPD患者肾上腺皮质功能与病情的关系  

The Clinical Significance of the Dysfunction of Adrenal Cortex in Patients with Asthma and COPD

作　　者：钱亚娟[1] 施敏骅[1] 

机构地区：[1]苏州大学附属第二医院呼吸科,江苏苏州215004

出　　处：《苏州大学学报（医学版）》2009年第3期514-517,共4页Suzhou University Journal of Medical Science

摘　　要：目的分析哮喘和慢性阻塞性肺病（COPD）患者主要临床特征与肾上腺皮质功能之间的关系。方法37例哮喘患者分为有夜间症状组（NA组）和无夜间症状组（NNA组）,根据控制情况分为部分控制组和未控制组。33例COPD患者根据病情严重程度分轻-中度组与重-极重度组,对所有患者进行肺功能测定并分别测定上午8时与下午4时血浆皮质醇水平。结果上午8时皮质醇水平哮喘组较COPD组显著下降,NA组较NNA组显著下降,差异均有高度统计学意义（分别P〈0.001和〈0.01）;未控制组与部分控制组、重-极重度组COPD患者与轻-中度组相比,差异均无统计学意义（均P〉0.05）。下午4时皮质醇水平除NA组较NNA组明显下降,差异有统计学意义（P〈0.05）外,其余哮喘组与COPD、未控制组与部分控制组、重-极重度组与轻-中度组的差异均无统计学意义（均P〉0.05）。COPD患者上午8时平均皮质醇水平显著高于下午4时,差异有高度统计学意义（P〈0.01）,哮喘组患者上午8时与下午4时的平均皮质醇水平接近甚至倒置。结论哮喘患者较COPD患者可能存在更明显的肾上腺皮质功能障碍和昼夜节律的紊乱,哮喘夜间症状的发生可能与此有关。Objective To investigate the relationship of serum cortisol level and the clinical condition and severity of asthma and chronic obstructive pulmonary disease（COPD） patients. Methods Thirty-seven patients with asthma and 33 patients with COPD were studied. They were classified according to the extent of severity. The lung function was monitored and the serum cortisol concentrations were measured at 8 a.m and 4 p.m in all patients. Results The cortisol level at 8 a.m in the asthma group was much lower than that in the COPD group （P〈0.001）. The cortisol level at 8 a.m in the nocturnal asthma（NA） group was much decreased than that in the non-nocturnal asthma（NNA） group （P〈0.01）. There was no statistic difference between serum eortisol level in the uncontrolled asthmatic group and the partly controlled asthmatic group （P〉0.05）. In the COPD group in mild to moderate stage the cortisol level at 8 a.m was higher, but there was no statistic difference between this group and the COPD group in severe to very severe stage （P〉0.05）. There was no statistic difference in serum cortisol concentration at 4 p.m between the patients in the asthma group and that in the COPD group（P〉0.05）. Cortisol level in the NA group was lower than that in the NNA group （P〈0.05）. However there was no statistic difference between the partly controlled asthmatic group and the uncontrolled asthmatic group. There was no statistic difference in the level of cortisol between the patients in the COPD group in mild to moderate stage and that in the group in severe to very severe stage（P〉0.05）. The level of cortisol at 8 a.m was significantly higher than that at 4 p.m in both COPD groups （P〈0.01）. However the difference was not observed in the asthma patients （P〉0.05）. Conclusion The dysfunction of adrenal cortex and disordered of circadian rhythm of cortisol are more significant in the patients with asthma than in the patients with COPD, which may be involved in the pathogenesis of nocturna

关 键 词：支气管哮喘 慢性阻塞性肺病 皮质醇 

分 类 号：R562.25[医药卫生—呼吸系统] R563[医药卫生—内科学]