在接受长期葡萄糖皮质激素治疗的移植患者中,下丘脑-垂体-上腺轴活动和代谢障碍
Stathis Tsiakas1, Anna Angelousi2, Vassiliki Benetou3
1Department of Nephrology and Renal Transplantation, Medical School, National and Kapodistrian University of Athens, Laiko Hospital, 11527 Athens, Greece.
Journal of clinical medicine
|November 27, 2024
概括
在移植接受者中使用葡萄糖皮质类药物经常会导致下丘脑-垂体-上腺 (HPA) 轴的抑制. 上皮质热激素 (ACTH) 可能预测HPA轴活性,但抑制在本研究中与代谢问题无关.
科学领域:
- 内分泌学 在内分泌学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 移植 移植 移植 移植
背景情况:
- 葡萄糖皮质类药物是移植接受者 (KTRs) 的标准维护免疫抑制剂.
- 长期使用葡萄糖皮质类药物可能导致下丘脑-垂体-上腺 (HPA) 轴的抑制.
- 在KTR中,HPA轴抑制与代谢障碍之间的关联还不清楚.
研究的目的:
- 为了确定HPA轴抑制在低剂量葡萄糖皮质激素的稳定KTR中的患病率.
- 调查HPA轴抑制与这一群体中的代谢障碍之间的关系.
- 评估ACTH作为HPA轴活性生物标志物的实用性.
主要方法:
- 在低剂量葡萄糖皮质激素的成年人KTR的横截面研究.
- 由早晨皮质醇<5μg/dL定义的HPA轴抑制.
- 评估了ACTH,脱水氨硫酸 (DHEAS),24小时尿液自由皮质醇 (UFC) 和代谢障碍 (高血压,失脂症,中心肥胖症,PTDM).
主要成果:
- 27.5%的KTRs (n=80) 显示HPA轴抑制.
- 抑制HPA轴与年龄较大和移植后时间较长有关.
- 基线皮质醇与ACTH,DHEAS和UFC正相关;ACTH显示HPA轴活动的预测值 (AUC=0.79).
结论:
- 慢性低剂量葡萄糖皮质激素的稳定KTR具有HPA轴抑制的高患病率.
- 在KTRs中,ACTH可以作为HPA轴活性的替代生物标志物.
- 在这个队列中,HPA轴抑制与研究的代谢障碍没有显著的关联.
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