The Effect Of Long-term Glucocorticoid Maintenance Therapy On HPA Axis In Patients With Systemic Lupus Erythematosus At Remission Stage

Objective To investigate the effect of long-term glucocorticoid maintenance therapy on the hypothalamic-pituitary-adrenal axis(HPA axis)in patients with systemic lupus erythematosus(SLE)at remission stage.Methods A total of 171 patients with SLE at remission stage were enrolled,including 166 women aged 18 to 74 years old(mean 37.25±11.00 years)with a duration of 1 to 28 years(average 7.30±5.27 years).All patients received prednisone for long-term(more than one year),SLE disease activity index(SLEDAI)≤ 4 points.54 normal controls were also recruited.The levels of serum adrenocorticotropic hormone(ACTH)and cortisol(COR)were detected in SLE patients and normal controls.According to the current dose of the prednisone,all the subjects were divided into 3 groups,the current dose of the prednisone ≤5mg/d,the current dose of the prednisone >5-7.5mg/d and the current dose of the prednisone>7.5mg/d.All the subjects were also divided into 3 groups according to the duration,duration<5 years,5 years <duration<10 years and duration≥10 years.According to the cumulative doses of the prednisone,all the subjects were divided into 2 groups,the cumulative doses of the prednisone≤ 18.25 g and > 18.25 g.The levels of ACTH and COR were detected by chemiluminescence immunoassay.Results The serum levels of ACTH and COR(27.32±25.50pg/ml,189.08±140.50nmol/L)in SLE group were significantly lower than those in normal control group(36.44±17.12pg/ml,371.57±93.91nmol/L),and the differences were statistically significant(P values were 0.015and<0.001,respectively).The levels of ACTH in ≤5mg/d group and >5 ~ 7.5mg/d group(40.92±40.90 pg/ml,36.77±23.06pg/ml)were higher than those in >7.5mg/d group(21.47±17.59 pg / ml)(P <0.05),and the differences were statistically significant(P <0.05).There was no significant difference between ≤5mg/d group,>5~7.5mg/d group and normal control group(36.44±17.12pg/ml)(all P values> 0.05)about the levels of ACTH.The level of ACTH in>7.5mg/d group was lower than the normal control group,and the differences were statistically significant(P <0.05).The levels of COR in 3 groups with different current doses of the prednisone were significantly lower than those in the normal control group(all P values < 0.05).Among the levels of ACTH and COR in group of duration<5 years,group of 5 years <duration<10 years and group of duration≥10 years,there were no significant differences(all P values> 0.05).The levels of ACTH and COR were no significant differences between the cumulative doses of the prednisone≤ 18.25 g and > 18.25g(P values were 0.357 and 0.138,respectively).Conclusions Long-term low-dose prednisolone maintenance therapy in SLE patients can lead to the decrease of ACTH and COR.The higher the current prednisone dosage,the more significant reduction of ACTH and COR levels.Both the duration and cumulative dose of prednisone have no connection with the HPA axis..The current dose of prednisone ≤ 7.5mg / d has no effect on ACTH levels,but even <5mg / d causes a decrease in COR levels.