严重感染患者下丘脑-垂体-肾上腺轴功能的再评价  

Reevaluation of the hypothalamic-pituitary-adrenal axis function in patients with severe sepsis or septic shock

作　　者：崔娜[1] 刘大为[1] 曾正陪[2] 王郝[1] 隆云[1] 刘宏忠[1] 王小亭[1] 芮曦[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 [2]中国医学科学院中国协和医科大学北京协和医院内分泌科,北京100730

出　　处：《中华内分泌代谢杂志》2007年第5期432-434,共3页Chinese Journal of Endocrinology and Metabolism

基　　金：首都发展基金(2003-1005)

摘　　要：应用化学免疫发光法分组测定10例严重全身性感染(危重组)和12例感染性休克(休克组)患者在病程早期(确诊后1,3,5d)血清皮质醇和血浆ACTH水平,与12例对照组患者进行对照分析;并进行1μg ACTH刺激试验评价严重感染患者下丘脑-垂体-肾上腺(HPA)轴功能。结果显示,与对照组相比,危重组的ACTH明显升高(P<0.05)。休克组的ACTH明显降低(P<0.05),ACTH与严重感染患者的病情危重程度密切相关(P<0.05),在存活组和死亡组间存在显著差异(P<0.05)。提示HPA轴在严重感染发生早期已经出现功能改变,ACTH水平与严重感染患者的病情危重程度及住院病死率密切相关。[Summary] Serum cortisol and plasma ACTH were determined in 10 patients with severe sepsis and 12 with septic shock on day 1, 3, 5 after diagnosis were made, and the data were compared with 12 control patients. To evaluate the hypothalamic-pituitary-adrenal （HPA） axis function in patients with severe sepsis and septic shock, 1 μg ACTH stimulation test was applied after hormone concentrations were obtained on day 1. Compared with the control patients, ACTH level was significantly higher in patients with severe sepsis and lower in septic shock （P 〈 0.05 ）, according to the APACHE Ⅱ and SOFA score, ACTH level was closely related to the severity of illness （P 〈 0.05 ）, and significant difference was found between survivors and non-survivors （ P 〈 0.01 ）, which suggests that HPA axis function has changed before the occurrence of septic shock and ACTH level is closely related to the severity and mortality in patients with severe sepsis and septic shock.

关 键 词：脓毒症 休克 脓毒性 下丘脑-垂体-肾上腺轴 ACTH刺激试验 

分 类 号：R459.7[医药卫生—急诊医学] R446.6[医药卫生—治疗学]