| Objective To investigate the role of adrenocorticotropic hormone(ACTH) in the pathogenesis of patients with SLE and explore the inhibition of different dosage form of glucocorticoid (GC) therapyMethods52recent onset SLE patients were included in the study,1male and51females with an average age of31.83±11.53years (14-68) and an average course of disease was15.47±28.18months. They were all in-hospital patients in the department of Rheumatology and Immunology of Anhui Provincial Hospital from May,2007to Apirl,2008. They were all in accordance with1997American College of Rheumatology Revised Criteria for Classification of Systemic Lupus Erythematosus. The control group was composed of20healthy subjects,4males and16females with an average age of28.90±5.13years (26-45) and without previous medical history of autoimmune diseases. The differences in sex and age between two groups were statistically insignificant. According to the SLE disease activity index (SLEDAI),the SLE patients were divided into different degrees:a severe degree (SLEDAI>15points) composed of28patients,1male and27females aged from17to68(30.39±12.37years in average)and a mild/moderate degree ((5points<SLEDAI<15points) composed of24patients, all are females aged from14to53(33.43±10.51years in average). The patients were divided into the different dosage form groups.:17severe and13mild/moderate patients to be treated with large dose dexamethasone and the other11severe and11mild/moderate patients to be treated with large dose methylprednisolone in the first week.and all of them treated with routine dose prednisone in the following three weeks.To detect the ACTH level of the blood samples from the patients" that treated with different dosages forms of GC in pre-and post-therapy and investigate the correlation between ACTH and the clinical and laboratorial indices. Independent Samples Group t Test with SPSS17.0software package was used to determine the differences between the SLE group and the corresponding control group; Multivariate Analysis of Variance (MANOVA) was used to determine the differences between the severe group, the mild/moderate group and its corresponding control group; Nonparametric Spearman Correlation Analysis was used to investigate the correlation between clinical indices and ACTH; and Paired-Samples T Test was used to compare pre-and post-therapy indices.Results The findings indicated that.(1) the ACTH level of SLE group was significantly higher than those of the control group before treatment (54.298±4.787vs34.752±3.916, p<0.05), the group of mild and moderate SLE patients especially the highest(62.033±6.076),but the differences of ACTH were statistically insignificant between the severe SLE patients and the control group (p>0.05);(2) The SLE patients ACTH was correlated positively with WBC count (r=0.365, P=0.004) and IgG (r=0.279. P=0.032), but uncorrelated with the lesion of kidney and skin, RBC, Hb, PLT,24-hour urinary protein excretion, Serum albumin, ESR, CRP, IgA, IgM, C3, C4and Anti-C1q (p>0.05), and it have the tendency of correlation with Anti-Nucleosome Antibody (AnuA)(P=0.087) and SLEADI (P=0.086). The levels of ACTH of patients with positive anti-SSB were significantly higher than those of patients with negative anti-SSB (p<0.05), but the differences in the levels of ACTH were statistically insignificant between the patients with negative anti-ds-DNA, anti-Sm, anti-SSA. anti-SnRNP and those with positive antibodies (p>0.05); and (3) there were no statistically significant differences in the levels of the ACTH between the groups treated with dexamethasone and methylprednisolone (p>0.05), and a comparison indicated that there was a marked drop in ACTH after the treatment within each group (p<0.05).Conclusions There were abnormall responses of ACTH in recent onset SLE Patients’which should be closely related to the pathomechanism of the disease. There were no differences of ACTH between two groups after a large dose different dosage forms of GC in short-term therapy. |
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