肠道病毒71型重症和危重症手足口病患儿肾上腺皮质功能状态评价  

Evaluation of adrenocortical function in children with severe and critical enterovirus 71 infection

作　　者：武洁[1] 成怡冰 李志方[3] 李玉芬[3] 李玉萍 许惠敏 李兴旺[5] 钱素云[1] 

机构地区：[1]首都医科大学附属北京儿童医院急救中心,100045 [2]郑州儿童医院儿童加强监护病房,450000 [3]山东省临沂市人民医院儿科,276000 [4]开封市儿童医院儿童加强监护病房,475000 [5]首都医科大学附属北京地坛医院,100015

出　　处：《中华儿科杂志》2012年第4期249-254,共6页Chinese Journal of Pediatrics

摘　　要：目的探讨大剂量促肾上腺皮质激素（adrenocorticotropic hormone，ACTH，250μg），在治疗手足口病中的价值。方法前瞻性、多中心调查评估重症和危重症肠道病毒71型（EV71）感染住院患儿的肾上腺皮质功能状态。①研究地点：本项目在首都医科大学附属北京儿童医院、郑州儿童医院、开封市儿童医院及山东省临沂市人民医院的儿童加强监护病房（PICU）中进行。②研究对象：2009年6月至2010年5月入住四所医院PICU临床诊断符合重症或危重症HFMD的患儿，同时进行EV71病毒核酸检测和大剂量（250μg）ACTH刺激试验，其中EV71病毒核酸检测为阳性的51例最终纳入本研究。③试验方法：患儿人住PICU6h内、使用糖皮质激素前，取血测定血清基础皮质醇（TO）浓度，之后静脉注射ACTH250μg，分别于注射后30min、60min取血测血清皮质醇水平（为T30、T60）。皮质醇的增值为ATmax=（T30、T60的最大值）-T0，肾上腺功能障碍（adrenal insufficiency，AI）的诊断标准为：ATmax≤90μg/L。结果①51例HFMD患儿中，AI发生率为52．94％（27／51），重症组与危重症组AI发生率分别为44．74％（17／38）和76．92％（10／13），差异有统计学意义（P〈0．05）。②进行危重病例评分（PCIS），≤70分组、≥90分组AI发生率分别为81．82％（9／11）、28．57％（4／14），两者比较差异有统计学意义（P〈0．05）。③死亡组、存活组AI的发生率分别为75％（6／8）、48．84％（21／43），差异无统计学意义（P〉0．05）。死亡组的T0值高于存活组（P〈0．05）。结论重症及危重症EV71感染患儿中AI发生率较高，EV71感染危重患儿更容易出现AI。AI可能影响重症与危重症EV71感染患儿预后。HFMD患儿确定或高度怀疑合并AI时，可能仍然需要补充一定量外源性糖皮质激素，激素使用方案需个体化，使用时机、剂量以及治疗疗程，则有�Objective To evaluate the adrenocortical function in children with severe and critical enterovirus 71 infection by using a high-dose （250μg） adrenocorticotropic hormone （ACTH） stimulation test. And to at provide experimental basis for glucocorticoid in the treatment of hand-foot-and-mouth disease （HFMD）. Method This was a prospective multi-center study which was carried out in PICUs of Beijing Children＇s Hospital, Zhengzhou Children＇s Hospital, Kaifeng Children＇s Hospital and Linyi People＇s Hospital in Shandong province. Children with severe and critical hand-foot-mouth disease admitted to PICUs of the four hospitals from June 2009 to April 2010 were enrolled in this study, and EV71 virus nucleic acid test and high-dose （250 μg） ACTH stimulation started at the same time. EV71 vires nucleic acid positive 51 cases were eventually enrolled in the study. Cortisol test was performed at baseline （T0） and after high-dose （250 μg） ACTH stimulation at 30 minutes （T30）, 60 minutes （T60） in the first 6 hours after admission,but before glucocorticoid was given. The adrenocortical function was evaluated according to ATmax [△Tmax = （ T30,T60 maximum） - TO ]. Diagnostic criteria of adrenal insufficiency （AI） is increment （△Tmax） ≤ 9 μg/dl. Result The incidence of AI in 51 cases was 52. 94% （27/51）. The incidence of AI in severe group was 44. 74% （17/38） , which was significantly higher in critical group 76. 92% （10/13） , P 〈0. 05. Of the cases with a pediatric critical illness score （PCIS） ≤ 70, 81.82% （9/11） had adrenal insufficiency, and it was 28.57% （4/14） when PCIS≥90. The incidence of AI was 75% （6/8） and 48.84% （21/43） in death and survivor group respectively, but there were no significant difference between the two groups （ P 〉 0.05 ）. Baseline （ TO ） cortisol in death group was higher than survivor group （ P 〈 0.05）. Conclusion AI may occur in children with enterovirus 71 infection. The critical enterovir

关 键 词：手足口病 肾上腺皮质功能减退 肠道病毒71型 重症监护病房 儿科 

分 类 号：R72[医药卫生—儿科]