uzspbgmuУчёные записки Первого Санкт-Петербургского государственного медицинского университета имени академика И. П. ПавловаThe Scientific Notes of the Pavlov University1607-41812541-8807Academician I.P. Pavlov First St. Petersburg State Medical University10.24884/1607-4181-2025-32-1-43-51uzspbgmu-1113Research ArticleОРИГИНАЛЬНЫЕ РАБОТЫORIGINAL PAPERSОсобенности эндокринного статуса у подростков с рассеянным склерозомFeatures of endocrine status in adolescents with multiple sclerosishttps://orcid.org/0000-0002-3358-5768ЛебедевВ. М.LebedevV. M.

Лебедев Валерий Михайлович, зав. отделением неврологии, младший научный сотрудник

197022, Санкт-Петербург, ул. Академика Павлова, д. 12а

Lebedev Valeriy M., Head of the Department of Neurology, Junior Research Fellow

12a, Academician Pavlov str., Saint Petersburg, 197022

lebedevvaleriy@bk.ruhttps://orcid.org/0000-0002-6715-8203ТотолянН. А.TotolyanN. A.

Тотолян Наталья Агафоновна, доктор медицинских наук, профессор кафедры неврологии

197022, Санкт-Петербург, ул. Академика Павлова, д. 12а

197022, Санкт-Петербург, ул. Льва Толстого, д. 6-8

Totolyan Natalia A., Dr. of Sci. (Med.), Professor of the Department of Neurology

12a, Academician Pavlov str., Saint Petersburg, 197022

6-8, L’va Tolstogo str., Saint Petersburg, 197022

ntotolyan@mail.ruИнститут мозга человека им. Н. П. Бехтеревой Российской академии наук (ИМЧ РАН)РоссияN. P. Bechtereva Institute of the Human Brain of the Russian Academy of Sciences (IHB RAS)Russian FederationИнститут мозга человека им. Н. П. Бехтеревой Российской академии наук (ИМЧ РАН); Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. ПавловаРоссияN. P. Bechtereva Institute of the Human Brain of the Russian Academy of Sciences (IHB RAS); Pavlov UniversityRussian Federation2025070620253214351Copyright © Лебедев В.М., Тотолян Н.А., 20252025Лебедев В.М., Тотолян Н.А.Lebedev V.M., Totolyan N.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.sci-notes.ru/jour/article/view/1113

Введение. Рядом авторов показаны изменения гормонального статуса у взрослых с рассеянным склерозом (РС) в сравнении со здоровыми добровольцами. В детской популяции такие исследования немногочисленны, проведены на небольших выборках, а их результаты неоднозначны и противоречат друг другу, что указывает на необходимость дальнейших исследований в данной области.Цель. Определение особенностей эндокринного статуса у подростков с РС в сравнении со здоровыми детьми и взрослыми пациентами с РС, оценка взаимосвязи уровней гормонов гипофиза, щитовидной железы, кортизола и половых гормонов с активностью и тяжестью течения РС у подростков и взрослых.Материалы и методы. Основную группу составили 33 пациента с педиатрическим РС подросткового возраста, группу сравнения – 22 взрослых с РС, группу контроля – 26 здоровых подростков. Всем участникам определяли концентрацию пролактина, фолликулостимулирующего гормона, лютеинизирующего гормона, адренокортикотропного гормона, тиреотропного гормона, тироксина (Т4) общего, Т4 свободного, трийодтиронина, кортизола, тестостерона, дигидротестостерона, эстрадиола, 17-ОН прогестерона. У пациентов с РС дополнительно оценены клинические и МРТ-характеристики заболевания.Результаты. Уровень пролактина у взрослых и подростков с РС достоверно выше, чем в группе контроля. У подростков с исходно более высоким уровнем кортизола отмечена более низкая степень выраженности двигательных нарушений (r=-0,59, p<0,001) и инвалидизации по расширенной шкале статуса инвалидизации (РШСИ) (r=-0,49, p=0,004). Похожая зависимость получена для 17ОН-прогестерона: у подростков с более высоким уровнем данного гормона отмечался более низкий уровень инвалидизации по РШСИ (r=-0,36, p=0,04). У взрослых пациентов с РС отмечена умеренная обратная взаимосвязь (r=-0,47, p=0,03) между уровнем 17ОН-прогестерона и степенью выраженности мозжечковых нарушений. У подростков с обострением РС отмечался более высокий уровень пролактина (p=0,04) и более низкий уровень 17ОН-прогестерона (p=0,02), чем в фазе ремиссии.Выводы. У подростков и взрослых с РС уровень пролактина достоверно выше, чем в контрольной группе подростков. Впервые показана обратная взаимосвязь между базальным уровнем эндогенных стероидных гормонов и тяжестью инвалидизации по ряду функциональных систем у подростков и взрослых. Продемонстрировано изменение уровня пролактина и 17ОН-прогестерона в фазе обострения РС у подростков, что позволяет рассматривать оба показателя как потенциальную мишень для разработки лабораторных маркеров реактивации болезни.

Introduction. A number of authors have shown changes of hormonal status in adults with multiple sclerosis (MS) compared to healthy volunteers. At the same time, there are few such studies in the pediatric population, conducted on small groups, with ambiguous and contradictory results, which indicates the need for further research in this area.The objective was to determine the endocrine status features in adolescents with MS in comparison with healthy children and adult patients with MS, to assess the relationship between the levels of pituitary hormones, thyroid hormones, cortisol, sex hormones and the activity and severity of MS in adolescents and adults.Methods and materials. The main group consisted of 33 adolescent patients with pediatric MS, the comparison group included 22 adult patients with MS, and the control group comprised 26 healthy adolescents. All participants underwent assessments for the concentrations of prolactin, follicle-stimulating hormone, luteinizing hormone, adrenocorticotropic hormone, thyroid-stimulating hormone, total and free thyroxine, triiodothyronine, cortisol, testosterone, dihydrotestosterone, estradiol, and 17-hydroxyprogesterone. In addition, clinical and MRI characteristics of the disease were evaluated in patients with MS.Results. Prolactin levels in adult and adolescent patients with MS were definitely higher than in a control group. Adolescents with higher cortisol levels at baseline showed a lower severity of motor dysfunction (r=–0.59, p<0.001) and disability as measured by the Expanded Disability Status Scale (EDSS) (r=–0.49, p=0.004). A similar correlation was found for 17-hydroxyprogesterone: adolescents with higher levels of this hormone had less disability according to EDSS (r=–0.36, p=0.04). Adult patients with MS showed a moderate inverse correlation (r=–0.47, p=0.03) between 17-hydroxyprogesterone levels and the severity of cerebellar dysfunction. Adolescents experiencing an MS exacerbation had higher prolactin levels (p=0.04) and lower 17-hydroxyprogesterone levels (p=0.02) compared to those in remission.Conclusion. In adolescents and adults with MS, prolactin levels were significantly higher than in a control group of healthy adolescents. For the first time, a negative correlation between the baseline levels of endogenous steroid hormones and the degree of disability in several functional systems has been demonstrated in adolescents and adults. Changes in prolactin and 17-hydroxyprogesterone levels during MS exacerbation have been observed in adolescents, suggesting that both indicators may be potential targets for developing laboratory markers for disease reactivation.

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The authors declare that there are no conflicts of interest present.