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題名 | 常用治療風濕免疫中藥對國人類風濕關節炎血中Cortisol及淋巴球糖固醇接受體與傾荷力影響=The Effect of Popular Anti-rheumatic & Immunosuppressive Herbs on Serum ACTH, Cortisol and Lymphocyte Steroid Receptor & Affinity in Chinese Patients with Rheumatoid Arthritis |
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作者 | 周昌德; |
期刊 | 行政院衛生署中醫藥年報 |
出版日期 | 19980500 |
卷期 | 16:1 1998.05[民87.05] |
頁次 | 頁65-78 |
分類號 | 413.3 |
語文 | chi |
關鍵詞 | 類風濕關節炎; 細胞激素; 腎上腺; 類固醇接受體; Rheumatoid arthritis; Cytokines; Adrenal gland; Steroid receptor; |
中文摘要 | 類風濕關節炎(RA)是一侵犯關節為主之團體免疫病,先前之已發現類風濕 關節炎之免疫異常與細胞激素,尤期是IL1、IL6與TNFα,及腎上腺異常有 關,治療此類疾病在西藥方面主要以非類固醇抗發炎劑,類固醇及其它免疫抑 制劑為主,而傳統治療風濕免疫之中藥則強調根據不同體辨證,給於不同類抗 發炎,免疫調理之藥物。類固醇為內生性,其作用在細胞內之steroid receptor。 本研究試圖瞭解中國人RA患者其腎上腺,steroid receptor 是否與正常人及 不同種族有差異,且常用抗風濕中藥,是否影響steroid receptor。在本研究 中我們共收集35例(17例活性期,18例非活性期)之類風濕關節炎病患。及30 例正常健康者當作對照組,以放射免疫法偵測RA病人及正常人血清中cortisol, steroid receptor density或affinity,另外實驗中在體外加入中藥後,中藥 對上述steroid receptor之影響。實驗結果顯示,RA病人血中cortisol 濃度 在活性期(active)患者較正常人有顯下降,而steroid receptor density與 上述相似即RA患者較正常人亦有顯著地下降。本研究使用之中藥,在體外實 驗中,顯示中藥包括麻杏薏甘湯、葛根湯、玉屏風散、桂枝、防風、晉耆、白 朮及雷公藤(除薏以仁湯外)對正常人皆有明顯增加steroid receptor,而中藥 對RA病人血中淋巴球之steroid receptor,除葛根湯及晉耆外,皆明顯地抑 制。總結,活性期之RA病患,其腎上腺功能有異常,亦即免疫不正常與腦下 垂體、下視丘、腎上腺系統異常有關。而此系統異常是否與本研究中RA病人 之steroid receptor降低有關,目前仍未清楚,另外不同中藥會改變類固醇 之receptor,且正常人與RA有完全相反之結果,值得未來進一步探討。 |
英文摘要 | Rheumatoid arthritis (RA) is an autoimmune disease. The association between immune aberrations of RA and cytokines, mainly IL1, Il6, TNFα, or disease and adrenal insufficiency has been noticed. The main treatment strategy for RA in Western medicines include non-steroid anti-inflammatory drugs, steroid and other immunosuppressive agents. In contrast, the conventional Chinese medicines for RA were started by identification of illness in human body constitution and then prescribed with some anti-rheumatic or immune-modulating herbs. The endogenous or exogenous glucocorticoid, after enter into the cells, are binding to the intracytoplasmic steroid receptors and then exert its action after a lipocort in produces. The present research try to understand whether serum cortisol or intracellular steroid receptor in Chinese RA has defects and is there any difference whencompare with the results in Caucasian With RA﹖ Besides, the common traditional anti-rheumatic herbs were taken to evaluate the impact of herbs on steroid receptors. In this study, we have collected 35 RA patients (17 active, 18 inactive) and 30 healthy subjects as a control. The cortisol level and steroid receptor density or affinity were measured by radioimmunoassay. The results showed serum cortisol was significantly decreased in patients with active RA when compared with control (p<0.05). Likewise, the steroid receptor density in patients with RA was decreased significantly when compared with control but this was not paralleled to the change of cortisol. Effect of herbs during in vitro study on the binding of steroid receptor has shown the different results in patients with RA and control. In control group, the majority of herbs (Ma-Shing-I-Gang-Tang, Ge-Geng-Tang, Yu-Paing-Fong-Shan, Gue-Chich, Chung-Ju, Fang-Fong, Jin-Chich, Pai-Ju and Triptergium or T2), except for Yi-Ying-Jen-Tang, could increase the steroid binding capacity or affinity. However, in RA patients, except for GE-Geng-Tang and Jin-Chich, most herbs tended to decrease steroid binding capacity or affinity. In summary, it has adrenal defect in active RA patients. The imune abnormality in this disease may relate with the abnormal HPA axis. It is unknown that the lower cortisol in RA may lead to or relate with the decreased steroid receptor density or affinity. Herb may change the receptor but again, it is not clear what's the mechanism to develop the wide variation of steroid receptor in patients with RA and control and this needs to study in the future. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。