The role of neuroendocrine system in the pathogenesis of rheumatic diseases (minireview).
The role of neuroendocrine system in the pathogenesis of rheumatic diseases (minireview).
复制标题
神经内分泌系统在风湿性疾病发病机制中的作用（小型评论）。
作者：
R. Imrich
神经内分泌和免疫系统之间的相互作用在维持和恢复体内平衡中起着重要作用。在易感个体中，神经内分泌系统功能障碍可能是风湿性疾病发病机制中的危险因素之一。神经内分泌功能改变的具体原因仍然没有完全阐明。在长期的临床前阶段，遗传、环境、行为和其他危险因素的积累可能导致神经内分泌、微血管和免疫系统维持的稳态机制的慢性失衡。在疾病活动期由体液和神经信号介导的慢性炎症应激以及针对神经内分泌系统结构的自身抗体可能进一步参与神经内分泌功能障碍。在类风湿性关节炎（RA）患者的一个子集中，下丘脑-垂体-肾上腺皮质轴的假定缺陷可能与发病机制有关。一些研究结果支持绝经前RA发病女性肾上腺功能障碍的概念。随后发展为RA的女性的硫酸脱氢表雄酮（DHEAS）血浆水平显著较低，表明神经内分泌功能障碍可能已经存在于临床前阶段，因此不仅是继发性的，因为正在进行的炎症过程。这些发现勾画了未来RA可能的一级预防的新前景。本文还就催乳素、生长激素、性激素及植物神经系统参与风湿性疾病的作用作一综述。进一步研究它们在其他风湿性疾病发病机制中的作用，可能会为优化其治疗提供新的前景。
Interactions between the neuroendocrine and immune system play an important role in maintaining and restoring homeostasis. In susceptible individuals a dysfunction of the neuroendocrine system may be one of the risk factors involved in the pathogenesis of rheumatic diseases. Specific causes of altered neuroendocrine function are still not fully elucidated. Accumulation of genetical, environmental, behavioral and other risk factors during long preclinical period may result in chronic imbalances in homeostatic mechanisms maintained by neuroendocrine, microvascular and immune systems. Chronic inflammatory stress mediated by humoral and neural signals during active stages of the disease and autoantibodies against the structures of the neuroendocrine system may further participate in the neuroendocrine dysfunction. In a subset of patients with rheumatoid arthritis (RA), an assumed defect of the hypothalamic-pituitary-adrenocortical axis may be implicated in the pathogenesis. Results of some studies support the concept of adrenal dysfunction in women with premenopausal onset of the RA. Significantly lower levels of dehydroepiandrosterone sulfate (DHEAS) plasma levels of women who subsequently developed RA indicate that neuroendocrine dysfunction may be present already in preclinical period and thus are not only secondary due to ongoing inflammatory process. These findings are sketching the new prospects of possible primary prevention of RA in the future. The role of some other hormones including prolactin, growth hormone, sex hormones and involvement of autonomic nervous system in relation with the rheumatic diseases is also reviewed in the paper. Further research concerning their role in the pathogenesis of other rheumatic diseases will possibly provide new prospects in optimizing their therapy.