活跃类风湿性关节炎中的个人皮质醇产生与治疗反应有关:一项试点,为期两年的研究
Maria G Filippa1, Maria P Yavropoulou2, Nikolaos I Vlachogiannis1
1First Department of Propaedeutic and Internal Medicine and Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Athens, Greece.
Mediterranean journal of rheumatology
|August 4, 2025
概括
在类风湿性关节炎 (RA) 患者中,较低的白天皮质醇产生预测治疗反应不佳. 在治疗前测量皮质醇水平可以帮助预测活跃的RA患者的长期结果.
科学领域:
- 类风湿病学 类风湿病学
- 内分泌学 在内分泌学.
- 临床免疫学临床免疫学
背景情况:
- "不成比例原则"描述了活跃类风湿性关节炎 (RA) 患者的皮质醇生产不足,这些患者面临慢性炎症.
- 在RA治疗开始/升级之前,较低的白天皮质醇水平与6个月后治疗反应较差相关.
研究的目的:
- 为了确定活跃的RA患者内源性皮质醇水平是否在两年后预测治疗反应.
- 评估基线皮质醇测量与长期抗风湿治疗疗效之间的关联.
主要方法:
- 在治疗前在活跃的RA患者中测量了早晨ACTH,皮质醇,DHEAS和白天唾液皮质醇 (08:00, 12:00, 18:00, 22:00).
- 在24名RA患者中,前性分析了基线荷尔蒙水平和两年后治疗反应之间的关联.
主要成果:
- 与缓解期患者相比,中度反应或没有反应的患者的基线皮质醇/ACTH比率和白天皮质醇产量显著降低.
- 基线白天皮质醇产量 (AUC>81.3) 预测24个月缓解,具有86%的特异性和65%的敏感性,独立于年龄,性别和CRP.
结论:
- 在活跃的RA中,在治疗开始/升级之前,较低的白天皮质醇产量可能预测不充分的长期治疗反应.
- 需要进一步的研究来证实白天皮质醇水平对RA的长期结果的预测价值.
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