気管支喘息患者の血清コーチゾール値について. 副腎皮質ホルモン投与および年齢との関連

Serum cortisol levels were examined in 94 patients with bronchial asthma in relation to dose of glucocorticoids and age. 1. The level of serum cortisol was significantly lower in group A patients, treated with glucocorticoids (prednisolone of 5mg/day or more) for more than 2 years, (2.4±1.2mcg/㎗) than in group B, treated with glucocorticoids (prednisolone of 5mg or less) for less than 2 years, (6.8±3.7mcg/㎗) (p<0.001) and in group C, treated without glucocorticoids, (12.6±3.9mcg/㎗) (p<0.001). The serum cortisol level was also significantly lower in group B than in group C (p<0.001). 2. The level of serum cortisol was significantly lower in patients over the age of 70 compared to that in those aged between 0 and 39 years (p<0.01) and those between 40 and 49 (p<0.05), and those between 50 and 59 (p<0.02). The level was also lower in patients between 60 and 69 compared to that in those between 0 and 39, however, this was not significant. These results demonstrate that the level of serum cortisol decreases by long-term glucocorticoid regimen and with aging.気管支喘息94例を対象に,副腎皮質ホルモン投与および年齢との関連のもとに,血清コーチゾール値の変動を観察した｡まず副腎皮質ホルモンの投与量および投与期間により以下の3群に分けて検討した｡グループA :副腎皮質ホルモン,プレドニソロンに換算して1日5mg以上を2年間以上にわたり使用している症例,グループB:プレドニソロン1日5mg以下で2年間以内の使用症例, グループC:副腎皮質ホルモンを全く使用していない症例｡その結果,グループAの血清コーチゾ-ル値(2.4±1.2mcg/㎗)は,グループB (6.8±3.7mcg/㎗)(p 0.01)やC(12.6±3.9mcg/㎗)(p 0.001)に比べ有意に低い値であった｡2､グループCでは,70才以上の症例の血清コーチゾ-ル値は,0-39才の症例(p 0.0l),40-49才の症例(p 0.05),そして,50-59才の症例(p 0.02)に比べ有意に低い値であった｡これらの結果は,血清コーチゾール値は,副腎 皮質ホルモンの投与量や投与期間以外にも､加齢による影響を受ける可能性を示唆している

ステロイド依存性重症難治性気管支喘息患者の血清コルチゾールに対する温泉療法の影響

Serum cortisol levels before and after spa therapy were compared in 30 patients with steroid-dependent intractable asthma (SDIA) in relation to clinical asthma types. 1. The mean level of serum cortisol in patients with type la-1 asthma was 2.0±0.7mcg/dℓ before spa therapy, and significantly increased to 9.0±3.1mcg/dℓ　(p<0.001). The serum cortisol level of patients with type la-2 also significantly increased from 3.3±1.5mcg/dℓ before spa therapy to 5.9±3.1 mcg/dℓ after the therapy (p<0.05). 2. The level of serum cortisol in patients with type Ib increased from 4.0±1.6mcg/dℓ to 7.8±1.4mcg/ dℓ after spa therapy (p<0.001). In contrast, the serum cortisol levels in patients with type II were not significantly different before (2.7±1.3mcg/dℓ) and after spa therapy (3.5±3.0mcg/dℓ). The results showed that an increase in the levels of serum cortisol by spa therapy was more clearly observed in patients with type la-1 asthma compared to that in type la-2 or type Ib, and that, in contrast, the serum cortisol levels in patients with type II asthma did not significantly increase by spa therapy, since their asthma attacks were always severe and chronic in spite of long-term glucocorticoid regimen.ステロイド依存性重症難治性気管支喘息患者30名において温泉療法前後の血清コルチゾール値を,臨床病型に基づいて検討した｡1.Ia-1型の症例における血清コルチゾール値は温泉療法前の2.0±0.7μg/dℓから9.0±3.lμg/dℓに有意に増加していた(p<0.001)｡Ia-2型でも3.3±1.5μg/dℓから5.9±3.1g/dℓに有意に増加していた(pく0.05)｡ 2.Ib型では温泉療法前後で4.0±1.6μg/dℓから7.8±1.4μg/dℓに有意に増加した｡一方,Ⅱ型の症例では,温泉療法前2.7±1.3μg/dℓ,温泉療法後3.5±3.0μg/dℓで有意な変化は認められなかった｡以上のように,温泉療法の血清コルチゾールに対する効果は,Ia-2,Ib型に比較してIa-1型で明らかであった｡一方,Ⅱ型の気管支喘息症例の血清コルチゾ-ル値は,温泉療法によって有意な変化を認めなかった｡これは長期にわたる副腎皮質ホルモン投与にかかわらず,Ⅱ型の症例の喘息発作は常に慢性的で重篤であるからと考えられる