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目的：根据急性呼吸窘迫综合征（ＡＲＤＳ）患者的糖皮质激素受体（ＧＲ）特异结合位点的变化，探讨在救治ＡＲＤＳ患者时糖皮质激素（ＧＣ）的合理使用方案。方法：研究对象为综合性ＩＬＵ中２８例ＡＲＤＳ患者，采用放射配体结合法测定ＡＲＤＳ患者外周血白细胞ＧＲ特异结合位点，２８例ＡＲＤＳ患者均行机械通气。随机的１１例ＡＲＤＳ患者（Ｂ组）进行ＧＣ治疗干预。当ＧＲ结合位点减少＜５０％时，地塞米松（Ｄｅｘ）按０．５ｍｇ·ｋｇ－１·ｄ－１使用；当ＧＲ结合位点减少≥５０％时，Ｄｅｘ按３～５ｍｇ·ｋｇ－１·ｄ－１使用。对照组为另１７例ＡＲＤＳ患者（Ａ组），不干预其ＧＣ的使用方案。结果：ＡＲＤＳ患者［ＧＲ（ｌ０１８．３±８２５．２）位点／细胞］显著低于正常人［ＧＲ（４６３４．１±４３６．５）位点／细胞］（Ｐ＜０．０１）。经用不同的Ｄｅｘ使用方案，Ａ组平均出现４．６个脏器功能衰竭，死亡率８８．３％。而Ｂ组平均出现２．１个脏器功能衰竭，死亡率为３６．４％。结论：根据ＧＲ特异结合位点决定使用ＧＣ方案有利于救治ＡＲＤＳ。
Objective: To investigate the rational use of glucocorticoid (GC) in the treatment of patients with ARDS according to the changes of glucocorticoid receptor (GR) binding site in patients with acute respiratory distress syndrome (ARDS). Methods: Totally 28 ARDS patients in the comprehensive ILU were enrolled in this study. Radioligand binding assay was used to determine GR specific binding sites of peripheral white blood cells in ARDS patients. All 28 ARDS patients underwent mechanical ventilation. Eleven patients with ARDS (Group B) were randomized to receive GC therapy. Dex was used at 0.5 mg · kg-1 · d-1 when the GR binding site was reduced by <50%; when the GR binding site was reduced by ≥50%, Dex was treated with 3 ~ 5 mg · kg- 1 · d-1 Use. Control group for the other 17 cases of ARDS patients (A group), do not interfere with the use of its GC program. Results: [GR (l018.3 ± 825.2) loci / cells in ARDS patients were significantly lower than those in normal controls [GR (4634.1 ± 436.5) loci / cell] (P <0.01). A group with an average of 4.6 organ failure, the mortality rate of 88.3%. In Group B, 2.1 organ failure occurred on average, with a mortality rate of 36.4%. Conclusion: The decision to use GC regimen based on GR specific binding sites is good for the treatment of ARDS.