THE EFFECT OF A HORMONE OF THE ADRENAL CORTEX (17-HYDROXY-11-DEHYDROCORTICOSTERONE - COMPOUND-E) AND OF PITUITARY ADRENOCORTICOTROPHIC HORMONE ON RHEUMATOID ARTHRITIS - PRELIMINARY REPORT
THE EFFECT OF A HORMONE OF THE ADRENAL CORTEX (17-HYDROXY-11-DEHYDROCORTICOSTERONE - COMPOUND-E) AND OF PITUITARY ADRENOCORTICOTROPHIC HORMONE ON RHEUMATOID ARTHRITIS - PRELIMINARY REPORT
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DOI：
10.1136/ard.8.2.97
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发表时间：
1949-01-01
影响因子：
27.4
通讯作者：
POLLEY, HF
中科院分区：
文献类型：
--
作者：
HENCH, PS;KENDALL, EC;POLLEY, HF
14例重度或中重度类风湿关节炎患者经复方E（可的松）治疗后，其临床特征和沉降率均有改善。作者认为类风湿关节炎是一种基本的生化紊乱。每天给药100 ~ 150毫克的化合物E，沉降率明显下降。血清球蛋白分数降低，A-G比值恢复正常。化合物E倾向于降低17-酮类固醇的分泌，但增加尿皮质激素的分泌。4例贫血患者血红蛋白升高，红细胞增加，在沉降率不下降的情况下，将剂量增加到150至200毫克，连续几天有效。只有一例在激素治疗前后对滑膜进行活组织检查。在本例中，组织学显示愈合的证据，但不正常。自1948年9月1日开始持续治疗的一名患者出现肾上腺素亢进的迹象。对2例类风湿关节炎患者行促肾上腺皮质激素（ACTH）肌注治疗。12天。每日剂量为100毫克。几天内僵硬、运动疼痛和关节压痛明显减轻。与使用化合物E时相比，沉降速率下降得更快、更稳定。促肾上腺皮质激素引起的生化改变如下：明显的疲惫感，短暂的气痛，胸部沉重，血压中度升高20 ~ 40mm。此外，血液和尿液中的氯化物、电解质和血液中的二氧化碳结合力以及尿液中17-酮类固醇和皮质类固醇的排泄也发生了变化。
Improvement in clinical features and the sedimentation rates were obtained in 14 patients with severe or moderately severe rheumatoid arthritis treated with Compound E (Cortisone). The authors believe rheumatoid arthritis to be a basic biochemical disturbance. The sedimentation rates dropped markedly under treatment with Compound E given in doses of 100 to 150 mg. daily. The serum globulin fraction diminished and the A-G ratio became normal. Compound E tended to lower the 17-ketosteroids excretion but urinary corti-coids increased. Hemoglobin in 4 anemic patients increased, erythrocytes increased and in instances in which the sedimentation rate did not drop, increasing the dose to 150 to 200 mg. daily for several days was effective. In only one instance were biopsies of the synovium taken before and after hormone treatment. In this instance, the histology showed evidence of healing, but was not normal. In one patient treated continually since Sept. 1, 1948, evidence of hyperadrenalism developed. Two patients with rheumatoid arthritis were treated with adrenocorticotrophic hormone (ACTH) intramusc. for 12 days. The daily dose was 100 mg. Striking reduction of stiffness, pain on movement and articular tenderness developed within a few days. The sedimentation rates dropped more promptly and steadily than when Compound E was employed. The biochemical alterations induced by ACTH were as follows: a marked sense of exhaustion, transient gas pains, heaviness in the chest and moderate elevation of blood pressure of from 20 to 40 mm. Also, there were alterations in the blood and urine chlorides, in the electrolytes and the CO2 combining power of the blood, and excretion of 17-ketosteroids and cortico-steroids in the urine.