中文摘要：

目的观察多发性硬化（multiple sclerosis,MS）患者下丘脑-垂体-肾上腺轴（hypothalamo-pituitaryadrenal axis,HPAA）的功能改变情况。方法选择作者医院60例非急性发作期MS患者（MS组）,以同期作者医院门诊健康体检者30名为健康对照（对照组）,采用酶联免疫吸附法（enzyme linked immunoassay,ELISA）检测早晨8点空腹血皮质醇（cortisol,CORT）、促肾上腺皮质醇激素（adrenocorticotropin,ACTH）、促肾上腺皮质醇激素释放激素（corticotropin releasing hormone,CRH）水平。MS组患者根据EDSS评分的不同,分为EDSS〉4.5组（10例）和EDSS≤4.5组（50例）两组;根据MS分型,分为复发缓解型MS（relapsing-remitting multiple sclerosis,RRMS）组（48例）和非复发缓解型MS（非RRMS）组（12例）两组。结果与对照组〔（55.67±32.48）ng/mL〕比较,MS组CORT〔（121.09±89.46）ng/mL〕表达升高（P=0.000）,与对照组〔（252.91±129.76）pg/mL〕比较,MS组ACTH〔（158.66±92.94）pg/mL〕表达下降（P=0.024）。不同性别之间上述指标比较差异无统计学意义（均P〉0.05）。EDSS评分〉4.5组〔（75.74±36.69）pg/mL,（159.37±27.99）pg/mL〕较EDSS≤4.5组〔（175.07±92.97）pg/mL,（217.11±65.34）pg/mL〕患者血清ACTH、CRH水平显著降低（P=0.001,P=0.032）。非RRMS组患者血清ACTH、CRH水平〔（101.62±57.02）pg/mL,（174.89±52.48）pg/mL〕与RRMS组〔（172.68±96.11）pg/mL,（215.61±64.89）pg/mL〕比较均显著下降（P=0.008,P=0.032）。结论 MS患者存在HPAA的功能紊乱。

英文摘要：

Objective To observe changes of the function of hypothalamo-pituitary-adrenal axis（HPAA）of patients suffering from multiple sclerosis（MS）,and the differences of HPAA function among different genders,MS types.Methods Sixty MS patients during remission（the MS group）were included.Adrenocorticotropin（ACTH）,corticotropin releasing hormone（CRH）,total cortisol（CORT）in serum at8∶00am were measured by enzyme-linked immunosorbent assay（ELISA）.The control group consisted of 30 healthy volunteers.According to different EDSS scores,MS patients were divided into EDSS〉4.5group（10cases）and EDSS ≤4.5group（50cases）.According to MS type,they were divided into relapsing-remitting MS（RRMS）group（48cases）and non-relapsing-remitting MS（non-RRMS）group（12cases）.Results Serum level of CORT [（121.09±89.46）ng/mL,P=0.000]was significantly higher and ACTH [（158.66±92.94）pg/mL,P=0.024]was lower comparing with those of the control group [（55.67±32.48）ng/mL,（252.91±129.76）pg/mL,respectively].Differences were not found between those of different genders in MS patients.Serum levels of ACTH and CRH in the EDSS high group（EDSS〉4.5）[（75.74±36.69）pg/mL,（159.37±27.99）pg/mL]were significantly lower than those in the EDSS low group（EDSS≤4.5）[（175.07±92.97）pg/mL,（217.11±65.34）pg/mL]（P=0.001,P=0.032）.Meanwhile,RRMS patients[（172.68±96.11）pg/mL,（215.61±64.89）pg/mL]presented significantly higher levels of ACTH and CRH in the serum comparing with the non-RRMS patients[（101.62±57.02）pg/mL,（174.89±52.48）pg/mL]（P=0.008,P=0.032）.Conclusions The HPAA functions were abnormal in MS patients,which played an important role in MS pathology.ACTH and CRH presented significantly lower levels in severer（EDSS〉4.5）and non-RRMS patients.