重症難治性喘息における副腎皮質ホルモン投与の影響

重症難治性喘息におけるステロイド剤の副腎皮質機能，免疫能に及ぼす影響を調べるため，喘息患者65例を過去3年間のステロイド剤使用状況により，Ⅰ群：依存性症例，Ⅱ群：時に使用する症例，Ⅲ群：非使用例の3群に分け，血清コルチゾール値，末梢血リンパ球数及び血清免疫グロブリンについて検討した。結果は，血清コルチゾール値：Ⅰ群4.0μg／dℓ，Ⅲ群11.6μg／dℓ，末梢血リンパ球数：Ⅰ群1，659／mm（3）Ⅲ群2，150／mm（3），I gG：Ⅰ群1，062mg／dℓ，Ⅲ群1．501mg／dℓ，IgA：Ⅰ群218mg／dℓ，Ⅲ群279mg／dℓ，IgM：Ⅰ群148mg／dℓ，Ⅲ群227mg／dℓとⅠ群はⅢ群に比べ有意に低い平均値を示しステロイド剤の副腎皮質機能，免疫能への抑制作用が窺われた。また末梢血リンパ球数の減少は，高齢者のステロイド依存性例に顕著であった。

In order to investigate adverse effects of steroid therapy on adrenocortical function and immune function, serum cortisol levels, peripheral lymphocytes' counts and serum immuno-globulin levels were examined in 65 asthmatic patients. The asthmatic patients were classified into 3 groups according to steroid therapy for the past 3 years ; group Ⅰ has been treated with continuous steroid therapy, group Ⅱ with occasional steroid therapy and group Ⅲ without steroid therapy. The results were as follows. 1. The mean of serum cortisol levels was lower significantly in group Ⅰ as compared with that in group Ⅲ, (groupⅠ:4.0μg/dℓ, groupⅢ:11.6μg/dℓ). 2. The average count of peripheral lymphocytes was more decreased in group Ⅰ than in group Ⅲ. The difference between the two groups was significantly, (group Ⅰ:1659/mm(3), group Ⅲ:2150/mm(3)). 3. The average levels of serum immunoglobinlins such as IgG, IgA and IgM was　 significantly lower in group Ⅰ compared with that in group Ⅲ, (group Ⅰ :IgG 1062mg/dℓ, IgA 218mg/dℓ, IgM 148mg/dℓ, group Ⅲ: IgG 1501mg/dℓ, IgA 279mg/de, IgM 227mg/dℓ). The results suggested that long-tetm steroid therapy remarkably suppressed adrenocortical function and immune function in patients with asthma.