严重感染患者下丘脑-垂体-靶腺轴功能的早期改变  

Early changes in function of hypothalamic - pituitary - target gland axis in patients with severe sepsis and septic shock

作　　者：崔娜[1] 刘大为[1] 王郝[1] 曾正陪[1] 隆云[1] 柴文昭[1] 刘宏忠[1] 王小亭[1] 

机构地区：[1]中国医学科学院中国协和医科大学北京协和医院ICU,北京100730

出　　处：《中国危重病急救医学》2007年第6期332-335,共4页Chinese Critical Care Medicine

基　　金：首都医学发展科研基金资助项目（2003-1005）

摘　　要：目的研究严重感染患者下丘脑-垂体-靶腺（HPTG）轴功能早期改变及其对病情危重程度和临床预后的影响。方法选择10例严重全身性感染患者（感染组）和12例感染性休克患者（休克组）在病程早期（确诊后1、3和5d）应用化学免疫发光法测定皮质醇（F）、三碘甲状腺原氨酸（T3）、甲状腺素（T4）、促甲状腺激素（TSH）、生长激素（GH）、催乳激素（PRL）、卵泡刺激素（FSH）和黄体生成素（LH）的血清含量以及促肾上腺皮质激素（ACTH）的血浆含量;同期选择12例非感染、非休克患者（对照组）进行对照分析。确诊后1d留取激素测定标本后,通过1μgACTH刺激试验评价严重感染患者下丘脑-垂体-肾上腺轴（HPAA）功能。结果感染组和休克组的ACTH、T3、T4、GH、FSH、LH和PRL均较对照组发生明显改变（P〈0.05或P〈0.01）,1μgACTH刺激试验结果显示,感染组无反应6例,有反应3例;休克组无反应9例,有反应2例,两组比较差异无显著性（P〉0.05）;以急性生理学与慢性健康状况评分系统（APACHE）和全身性感染相关器官功能衰竭评分系统（SOFA）为标准,ACTH、T3、T4、GH和PRL的变化与严重感染患者病情危重程度密切相关（P〈0.05或P〈0.01）;存活组与死亡组ACTH、T3、T4的差异非常显著（P〈0.05或P〈0.01）;ACTH、T4和SOFA评分与严重感染患者28d住院病死率独立相关（P〈0.05或P〈0.01）。结论严重感染发生早期出现的HPTG轴功能改变与患者病情危重程度及住院病死率密切相关。Objective To investigate the early changes in function of hypothalamic - pituitary - target gland （HPTG） axis in patients with severe sepsis and septic shock, in order to clarify its relationship with severity and prognosis of the patients. Methods The serum contents of cortisol （F）, triiodothyronine （T3）, thyroxine （T4）, thyrotropicstimulating hormone （TSH）, growth hormone （GH）, folliclestimulating hormone （FSH）, luteotropic hormone （LH）, prolactin （PRL） and plasma concentration of adrenocorticotrophic hormone （ACTH） in 10 severe sepsis and 12 septic shock patients on day 1, 3, 5 after diagnosis was made, and 12 patients with no infection or septic shock served as controls. The hypothalamicpituitary adrenal gland axis （HPAA） function of the patients with severe sepsis and septic shock were evaluated with 1μg ACTH stimulation test given 1 day after the concentrations of the above hormones were determined. Results Compared with the control patients, ACTH, T3, T4, GH, FSH, LH and PRL levels were significantly changed in patients with severe sepsis and septic shock （P〈0.05 or P〈0.01）. The numbers of patients with reaction to 1 μg ACTH stimulation test were similar between patients with severe sepsis （6 cases non - reaction and 3 cases reaction） and patients with septic shock （9 cases non reaction and 2 cases reaction, P〉0.05）. According to the acute physiology and chronic health evaluation K （APACHE K ） and sepsis -related organ failure assessment （SOFA） score, changes in ACTH, T3, T4, GH and PRL levels were closely related to the severity of illness （P〈0. 05 or P〈0.01）. Significant differences were found in ACTH, T3, T4 levels between survivors and non -survivors （P〈0. 05 or P〈0. 0l）. ACTH, T4 levels and SOFA score were independent predictors of the 28 -day hospital mortality （P〈0.05 or P〈0. 01）. Conclusion The early changes in HPTG axis are closely related with the severity and hospital mortality in patients with severe

关 键 词：感染 休克 感染性 下丘脑-垂体-靶腺轴 激素 

分 类 号：R686[医药卫生—骨科学]