脓毒症早期儿童相对肾上腺皮质功能不全激素干预的作用  

The influence of the hormonal intervention in children sepsis early relative adrenal insufficiency

作　　者：黄小霏[1] 潘志伟[1] 范联[1] 

机构地区：[1]广东省佛山市妇幼保健院儿科,528000

出　　处：《实用医学杂志》2013年第5期740-742,共3页The Journal of Practical Medicine

基　　金：佛山市科技局项目(编号:200908073)

摘　　要：目的:检测脓毒症患儿外周血皮质醇及糖皮质激素受体(glucocorticoid receptor,GR)水平,评价应激剂量外源性糖皮质激素(glucocorticoid,GC)治疗对小儿脓毒症是否具有保护作用。方法:对于符合相对肾上腺皮质功能不全(relative adrenal insufficiency,RAI)的患儿(治疗前查血浆皮质醇,以血浆随机皮质醇水平<690.0nmol/L为标准)随机分为观察组(10例)和对照组(10例)。观察组在常规治疗基础上给予小剂量激素(甲基强的松龙,methylprednisolone,MP)治疗;对照组给予常规治疗。于治疗前及治疗后第3天检测患儿GRα及GRβ mRNA水平。通过组内治疗前后对比及组间比较观察小剂量GC对脓毒症合并RAI患儿GRα及GRβ mRNA表达的影响。结果:(1)GRα及GRβ mRNA荧光定量PCR检测情况:GRα mRNA表达良好,GRβ mRNA不表达。(2)观察组与对照组比较:治疗后观察组GRα mRNA表达水平较对照组降低,差异有统计学意义(P<0.05)。(3)观察组治疗前后比较:观察组治疗后GRα mRNA表达水平较治疗前明显降低,差异有统计学意义(P<0.05)。结论:应激剂量外源性GC治疗脓毒症有临床意义。Objective To evaluate the protective effect of stress-dose exogenous glucocorticoid （GC） treatment on sepsis children by detecting the peripheral blood cortisol and glucocorticoid receptor （GR） level in sepsis children. Methods The relativity adrenal insufficiency （RAI） children（plasma cortisol was detected before treatment , with the random plasma eortisol levels 〈 690.0 nmol/L for the standard） were randomly divided into observation group （10 cases） and control group （10 cases）. Observation group was given low-dose methylprednisolone （MP） treatment and routine treatment. Control group was given routine treatment. GRα and GRβ mRNAs were detected before treatment and three days after treatment. Results （1）By quantitative PCR, GRα mRNA was detect in the two group, while GRβ mRNA could not be detected. （2）The GRα mRNA level of the observation group after treatment was significantly lower than that of the control group （P 〈 0.05 ）. （3）The GRα mRNA level of the observation group after treatment was significantly lower than that of the group before treatment （P 〈 0.05）. Conclusion Stress-dose exogenous GC has clinical significance in the treatment of sepsis.

关 键 词：脓毒症 相对肾上腺皮质功能不全 激素 儿童 

分 类 号：R720.597[医药卫生—急诊医学]