Impairment of neutrophilic glucocorticoid receptor function in patients treated with steroids for septic shock

被引：12
作者：
Bergquist M. [1 ,2 ]
Lindholm C. [2 ]
Strinnholm M. [3 ]
Hedenstierna G. [1 ]
Rylander C. [4 ]
机构：
[1] Department of Medical Sciences, Clinical Physiology, Uppsala University, Uppsala
[2] Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg
[3] Department of Anesthesia and Intensive Care, Kungälv Hospital, Kungälv
[4] Department of Anesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg
来源：
Intensive Care Medicine Experimental | / 3卷 / 1期
关键词：
Cortisol; Dexamethasone; Glucocorticoid receptor; Human; Hydrocortisone; Septic shock;
D O I：
10.1186/s40635-015-0059-9
中图分类号：
学科分类号：
摘要：
Background: Glucocorticoid (GC) treatment has variable effect in sepsis. This may be explained by decreased expression or function of the glucocorticoid receptor (GR). The aim of this study was to determine GR expression and binding capacity in patients during and after sepsis. Methods: In this prospective, non-interventional clinical study, peripheral blood and clinical data were collected from 20 adult patients at five timepoints during sepsis and 5–13 months after recovery. GR expression and binding capacity were assessed by flow cytometry. Results: GR expression was higher in T lymphocytes from patients with septic shock compared to healthy subjects (p = 0.01). While there was no difference in GR expression between GC-treated and non-treated patients, GR binding capacity was lower in GC-treated patients at admission compared to healthy subjects (p ≤ 0.03). After the acute inflammation inflammatory phase, GR binding capacity was still lower in neutrophils of GC-treated patients, compared to healthy subjects (p = 0.01). On admission, GR binding capacity in T lymphocytes and neutrophils was inversely correlated with noradrenaline dose and lactate (p ≤ 0.03). Conclusions: Our data suggest that GR expression is increased in T lymphocytes during septic shock regardless of GC treatment, while GR binding capacity is decreased in neutrophils in GC-treated patients. As neutrophils are the predominant circulating leucocyte in septic shock, their decreased GR binding capacity may impede the response to exogenous or endogenous glucocorticoids. © 2015, Bergquist et al.
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页数：15
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