糖皮质激素治疗血小板减少并发类固醇糖尿病临床研究

目的分析糖皮质激素治疗血小板减少并发类固醇糖尿病的临床效果.方法选取114例血小板减少患者进行激素冲击疗法,在治疗的过程中并发类固醇糖尿病21例,将患者按照并发症情况分为两组,观察组(非糖尿病组)和对照组(糖尿病组),分析两组的临床特点.结果 114例患者在激素冲击疗法过程中并发类固醇糖尿病21例.两组患者一般情况中性别差异较大,在年龄、体质量指数、c反应蛋白方面对照组明显高于观察组,差异具有统计学意义(P0.05);对照组复发率占23%,明显高于对照组的6.4%,差异具有统计学意义(P0.05);观察组溃疡、皮炎、感冒、泌尿感染发生率均较对照组降低,差异无统计学意义(P0.05).结论在应用糖皮质激素治疗血小板减少过程中,易发生类固醇糖尿病,在控制各危险因素的同时,治疗期间要及时监测血糖,对于确诊患者应及早采用降糖药物干预治疗.     

The effect of hydrocortisone and thyroxine on development of calcium homeostasis in embryonic intestinal epithelium

Cytoplasmic Ca²⁺ concentration of epithelial cells from 14-day embryonic chick duodena decreased during 72 h of organ culture to a value 54% of that found at 17 days in vivo. The ability of cells to maintain a constant Ca²⁺ concentration when challenged with high extracellular calcium was also significantly reduced. Addition of 1 M hydrocortisone during culture restored both parameters of Ca²⁺ homeostasis to that of 16-day uncultured duodena, and rise in cytoplasmic Ca²⁺ was significant within 4 h of hormone treatment. Thyroxine influenced epithelial Ca²⁺ similarly, but to a lesser degree and only after 48–72 h of culture. These data indicate that glucocorticoids, and possibly thyroid hormones, influence the development of calcium homeostasis in intestinal epithelium.     

Human and rodent type 1 11β-hydroxysteroid dehydrogenases are 7β-hydroxycholesterol dehydrogenases involved in oxysterol metabolism

Interconversion between cortisone and the glucocorticoid receptor ligand cortisol is carried out by 11-hydroxysteroid dehydrogenase (11-HSD)isozymes and constitutes a medically important example of pre-receptor control of steroid hormones. The enzyme 11-HSD type 1 (11-HSD1) catalyzes the conversion of cortisone to its active receptor-binding derivative cortisol, whereas 11-HSD type 2 performs the reverse reaction. Specific inhibitors against the type 1 enzyme lower intracellular levels of glucocorticoid hormone, with an important clinical application in insulin resistance and other metabolic disorders. We report here on the in vitro oxysterol-metabolizing properties of human and rodent 11-HSD1. The enzyme, either as full-length, membrane-attached, or as a transmembrane domain-deleted, soluble form, mediates exclusively conversion between 7-ketocholesterol and 7-hydroxycholesterol with similar k_cat values as observed with glucocorticoid hormones. Thus, human, rat, and mouse 11-HSD1 have dual enzyme activities like the recently described 7-hydroxysteroid dehydrogenase/11-hydroxysteroid dehydrogenase from hamster liver, but differ fundamentally from the latter in that 7-OH rather than 7-OH dehydrogenase constitutes the second activity. These results demonstrate an enzymatic origin of species differences in 7-oxysterol metabolism, establish the origin of endogenous 7-OH cholesterol in humans, and point to a possible involvement of 11-HSD1 in atherosclerosis.Received 30 December 2003; received after revision 16 February 2004; accepted 16 February 2004     

用双能X线吸收法测量糖皮质激素治疗者腰椎和近端股骨骨密度

为了观察糖皮质激素（ＧＣ）对骨矿物质密质的影响，采用双能Ｘ线吸收法（ＤＥＸＡ）对照测量了９４例ＧＣ治疗的患及年龄、性别匹配的９４例正常健康的腰椎２－４（Ｌ２－Ｌ４）和右侧近端股骨（股骨颈、大转子和Ｗａｒｄ‘ｓ三角区）的骨密度（ＢＭＤ），结果表明：ＧＣ治疗的２Ｌ２－Ｌ４，右侧股骨近端的ＢＭＤ测量值明显低于年龄和性别匹配的正常健康，绝经前和绝经后女性ＢＭＤ测量值减低，而男性患只出现近端股骨ＢＭ