Efficacy of inpatient treatment for atopic dermatitis evaluated by changes in serum cortisol levels
Efficacy of inpatient treatment for atopic dermatitis evaluated by changes in serum cortisol levels
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DOI：
10.1111/j.1346-8138.2012.01678.x
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发表时间：
2013-01-01
影响因子：
3.1
通讯作者：
Mukai, Hideki
中科院分区：
文献类型：
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作者：
Fukuda, Hidetsugu;Suzuki, Taku;Mukai, Hideki
当治疗患有严重特应性皮炎（AD）的患者时，住院治疗有助于在短时间内缓解皮肤症状。我们之前发现许多严重AD患者入院时血清皮质醇水平较低。本研究通过比较入院时与出院时的血清皮质醇、血浆促肾上腺皮质激素（ACTH）、血清胸腺和活化调节趋化因子（TARC）以及血清乳酸脱氢酶（LDH）水平来评估29名成人AD患者的住院治疗效果。出院时血清皮质醇和血浆 ACTH 水平显着升高。另一方面，出院时血清 TARC 和血清 LDH 显着降低。我们通过分析下丘脑垂体肾上腺皮质功能与睡眠障碍存在/不存在、血清皮质醇水平和每日尿游离皮质醇的关系，检查了入院时出现的下丘脑垂体肾上腺皮质功能抑制是否可归因于睡眠障碍导致的昼夜节律紊乱。入院时血清皮质醇水平较低的 17 例患者中，15 例（88.2%）入院时存在睡眠障碍。然而，每日尿游离皮质醇从 8.0 +/- 5.5 微克/天（入院时）显着增加至 18.5 +/- 17.2 微克/天（出院时）。这些结果表明，入院时出现的内分泌功能抑制并非归因于睡眠障碍导致的昼夜节律紊乱，而是真正的内分泌系统抑制。这些结果表明住院护理对于治疗严重AD患者非常有用，可以有效改善皮肤状况并从受抑制的内分泌功能中恢复。
When dealing with patients with severe atopic dermatitis (AD), inpatient treatment is useful for alleviating skin symptoms in short periods of time. We previously found that many severe AD patients had low serum cortisol levels at admission. The present study was undertaken to evaluate the efficacy of inpatient treatment in 29 adults with AD through comparisons of serum cortisol, plasma adrenocorticotropic hormone (ACTH), serum thymus and activation-regulated chemokine (TARC), and serum lactate dehydrogenase (LDH) levels at admission with those at the time of discharge. Serum cortisol and plasma ACTH levels were significantly higher at discharge. On the other hand, serum TARC and serum LDH were significantly lower at discharge. We examined whether the suppression of hypothalamicpituitaryadrenocortical function that was seen at admission was attributable to disturbed circadian rhythms due to sleep disorders by analyzing hypothalamicpituitaryadrenocortical function in relation to the presence/absence of sleep disorders, serum cortisol levels and daily urinary free cortisol. Of the 17 patients with low serum cortisol levels upon admission, 15 (88.2%) had sleep disorders upon admission. However, the daily urinary free cortisol increased significantly from 8.0 +/- 5.5 mu g/day (at admission) to 18.5 +/- 17.2 mu g/day (at discharge). These results suggested that the suppression of endocrine function seen at admission was not attributable to disturbed circadian rhythms due to sleep disorders but represented true suppression of the endocrine system. These results indicated that inpatient care was useful for treating patients with severe AD, enabling efficient improvement of the skin condition and recovery from suppressed endocrine function.