Nghiên cứu sự biến đổi nồng độ cortisol máu, chức năng tiết cortisol của tuyến thượng thận ở bệnh nhân viêm khớp dạng thấp tt tiếng anh

1 INTRODUCTION The necessity of thesis Rheumatoid arthritis (rheumatoid arthritis) is a typical systemic autoimmune disease, with chronic inflammatory manifestations in many peripheral joints, accompanied by extracellular and systemic manifestations of varying degrees, complex movements trash has serious consequences In patients with rheumatoid arthritis, chronic inflammation causes internal changes to affect the function of endocrine glands, including the hypothalamic-pituitary-adrenal axis (hypothalamo -pituritinadrenal, HPA) Patients with rheumatoid arthritis often use long-term glucocorticosteroids (GC) to treat the disease, which also contributes to the decline of HPA axis activity In the world, there are many studies in-depth about the mechanism of immune disorders, hormonal, cellular and humoral changes, related to the clinical manifestations, progress and treatment response of the rheumatoid arthritis disease In Vietnam, no research has focused on the change of cortisol and related hormone levels and the pathophysiological mechanisms of interactions between endogenous anti-inflammatory hormones of patients with the stage and level of disease activity of rheumatoid arthritis We found that the study of day-to-day changes in hormone levels of cortisol and hormones that stimulate it is ACTH in patients with rheumatoid arthritis may shed some light on the physiological mechanism of pathology of interactions between gland functions Endocrine and activity levels of rheumatoid arthritis From there, we can apply more effective approaches to treating rheumatoid arthritis in our country The topic "Study on changes in blood Cortisol concentration, cortisol function of adrenal gland in patients with rheumatoid arthritis" is conducted with the following two objectives: Survey of cortisol, ACTH, cortisol / ACTH blood ratio in rheumatoid arthritis patients 2 Analysis of the relationship between cortisol, ACTH, cortisol / ACTH blood ratio with disease activity and disease stage in rheumatoid arthritis patients *Scientific significance Quantifying ACTH, cortisol partially reflects the HPA axis activity with inflammatory response, finding an association between inflammation in rheumatoid arthritis and HPA axis dysfunction, according to the level of disease activity advanced stage of rheumatoid disease *Practical significance -ACTH, Cortisol levels at and 23 hours in the GC group had a lower median value than the non-GC and control groups -There is a moderate correlation (r = 0.41; r = 0.34) between ACTH and cortisol blood levels in both non-GC groups, using GC and the relationship between blood cortisol / ACTH ratio with the level of disease activity and the stage of rheumatoid arthritis Only multivariate correlation between concentration of Cortisol hours and serum CRP concentration with p 0,05 42,46±37,86 Moderate 29,57 (12,15(3,2-5,1) 90,09) 90,88±180,56 Strong 42,26(24,45(>5,1) 91,22) * p p1>0,05 (*) Variables are presented as medians (IQR-quartet) Moderate (3,2-5,1) GC users (2) (n=66) ( ± SD; median; IQR) 50,49±48,72 28,59(20,8862,78) 61,73±68,91 39,38(18,7677,28) * p2>0,05 63,98± 41 52,72(42,1081,75) 78,54±68,11 54,36(27,26116,4) p2>0,05 17 This Cortisol / ACTH ratio is presented in units of nmol / pmol The concentration of Cortisol / ACTH 8h, 23h in a group that does not use GC and the GC group with a high level of disease activity, the ratio of Cortisol / ACTH has a median value higher than the level of moderate disease activity; There was no statistical significance with (p1> 0.05, p2> 0.05) Table 3.28 and table 3.29 ACTH concentration hours, 23 hours in the group without GC had increased median according to the disease stage In contrast, the ACTH concentration of h, 23 h in the GC group had a decreased median according to the disease stage, with p2> 0.05 Cortisol levels of hours, 23 hours in both groups had a decrease in median according to the disease stage Table 3.30 The ratios of Cortisol / ACTH hours, 23h of the study groups according to the stage of disease Ratio: Cortisol/ACTH (nmol/pmol) Injury matches Steinbroke r stage stage stage 3-4 p stage Non-GC users (1) (n=70) (± SD;median; IQR) GC users (2) (n=70) ( ± SD; median; IQR) 129,57± 283,05 49,25 (27,54134,64) * 115,14±144,59 47,95 (30,03180,94) * 53,14±62,54 31,71(4,1377,65)* p1>0,05 75,44±153,25 39,43 (18,33- 60,53±67,81 38,77 (19,6975,25)* 48,79±55,58 18,81(8,9883,74)* 94,86±59,68 69,45(47,46153,80) p2>0,05 69,96±56,62 51,36(27,62- 18 82,36)* 107,84) 50,99±42,32 64,59±76,09 stage 35,93 (24,5937,19(12,9678,16) 88,82)* 56,65±58,40 90,12±80,09 stage 3-4 32,96 (8,7963,02(35,8880,58)* 167,65 ) p p1>0,05 p2>0,05 (*) Variables are presented as medians (IQR-quartet) This Cortisol / ACTH ratio is presented in units of nmol / pmol Cortisol / ACTH ratio 8h, 23h: in the non-GC group, median decreased gradually according to the disease stage, with p1> 0.05, in the GC group with median at Stage and lower than Stage 34,however with p2> 0.05 CHAPTER IV: DISCUSSION 4.1 General features Gender, age: female accounts for 85.7%; male accounted for 14.3%, age 60 years old 32.1%, age of medium 53.49 ± 12.2 Our results are also consistent with the results of other studies Disease detection time 3.87 ± 2.72 years, the number of swollen joints 9.71 ± 3.95; number of painful joints 11.55 ± 2.97, duration of morning stiffness 66.18 ± 9.49 minutes, pain level VAS (mm) 57.75 ± 9.04 mm Compared with Imran M.Y et al (2015) number of swollen joints 2.6 ± 3.18; Pain joint number 4.54 ± 4.35 The rate of anemia is 87.1%, the first time ESR: 57.53 ± 40.62 mm; RF (+) accounted for 72.6% Osteoarthritis of stage I occupies the highest 79.7% According to Isik A et al (2007) RF (+) 84.1%, ESR: 42.5 ± 26.9mm Imran M Y et al (2015) RF (+) 100% * Results DAS 28 - ESR: 5,30 ± 1,06, strong activity level accounts for 66.4%; moderate is 31.2%; mild 2.4% According to Son K.M et al (2011), Tran Thi Minh Hoa (2011) similar results 19 4.2 Concentrations of cortisol, ACTH, cortisol / ACTH ratio in patients with rheumatoid arthritis 4.2.1 Compare blood levels of ACTH and Cortisol 8h and 23h between study groups Cortisol levels of hours, 23 hours in the group did not use GC according to median respectively: (67.94, 17.18) ng / ml higher than the GC group (14.65, 13.51) ng / ml and lower than control group ( 60.03, 23.28) ng / ml Except for cortisol 8h, there is median with 67.94 ng / ml, higher than control group 60.03ng / ml, with p1,3> 0,05 According to Kanik et al (2000), Mirone L et al (1996); and Straub et al (2002) our results are lower Cortisol concentrations h, 23h in the GC group using median respectively (14.65; 13.51) ng / ml were lower than those of median in turn (60.03; 23.28) ng / ml Luu Thi Binh (2016), Tran Quang Nam (2014) and even Kirwan et al (2006) our results are lower ACTH concentrations at o'clock in the non-GC group, according to median 13.25pg / ml lower than control group 14.55 pg / ml and ACTH concentrations at 23h are lower than control group Our results are similar to Kanik et al (2000); Zoli A et al (2002) and Lower Straub et al (2002) The ACTH concentration was 8h, 23 h in the GC group using median lower than the non-GC group According to Gudbjornsson B et al (1996), the results are similar to ours The cortisol 8h concentration in the non-GC group at male 124.24 ± 88.79 ng / ml was higher than the female 68.51 ± 55.62 ng / ml In the GC group at male the median 13.74 ng / ml lower than female 14.95 ng / ml Normal WC was lower median than WC increase The cortisol concentration of 23 h in the non-GC group in male had median 23.05 ng / ml, which was higher than female 16.97 ng / ml According to Zoli A et al (2002) the results differ from ours, so compare some other authors The concentration of cortisol 8h in the GC group ≥ month median 14.78 ng / ml is lower than the group without GC 69.76 ng / ml, similar to the result of cortisol 23h concentration According to 20 Kirwan et al (2006) there are some similarities with us Luu Thi Binh (2016) has the opposite result The concentration of ACTH 8h in the group that did not use GC under disease detection time (DDT)