原发性肾病综合征隔日激素治疗患儿肾上腺皮质功能状态研究  

Study of adrenal function in children with primary nephrotic syndrome

作　　者：赵晓艳[1] 都娟[1] 黄建萍[1] 王硕[1] 肖丽丽[1] 

机构地区：[1]北京军区总医院附属八一儿童医院肾脏和免疫科,北京100700

出　　处：《中国实用儿科杂志》2013年第8期598-600,共3页Chinese Journal of Practical Pediatrics

基　　金：北京市科委首都市民健康培育项目(Z111107067311019)

摘　　要：目的探讨原发性肾病综合征(primary nephrotic syndrome,PNS)患儿隔日使用激素治疗时肾上腺皮质功能的状态。方法选取2012年1月至2013年1月北京军区总医院附属八一儿童医院肾脏和免疫科17例PNS患儿(肾病组,激素隔日用量<1 mg/kg)和7例仅有镜下血尿患儿(对照组)为研究对象,进行小剂量促肾上腺皮质激素(ACTH)兴奋试验评价肾上腺皮质功能。不服激素日14:00静脉注射ACTH1-39,分别在0、10、20、30、40、50、60 min分别取血测皮质醇。ACTH1-39注射后任意时间点皮质醇>497 nmol/L为正常反应。观察比较肾病组和对照组小剂量ACTH1-39兴奋试验检测出肾上腺皮质功能正常和低下的例数,肾病组和对照组在0、10、20、30、40、50、60 min各点时血皮质醇。结果17例PNS患儿中,肾上腺皮质功能低下7例,正常10例;对照组7例均显示肾上腺皮质功能正常。肾病组血皮质醇基础值低于对照组,但差异无统计学意义(P>0.05);20、30、50及60 min时,肾病组明显低于对照组(P<0.05);肾病组ACTH注射后30 min皮质醇均值>497 nmol/L,而对照组10 min即已超过该值。与对照组各个时间点比较,肾上腺皮质功能低下的7例患儿皮质醇均低(P<0.05),肾上腺皮质功能正常的10例患儿皮质醇也均降低,但差异无统计学意义(P>0.05)。ACTH注射后10 min肾病组皮质醇均值仍<497 nmol/L,对照组已超过此值;30 min时58.82%患儿达到正常反应,对照组100%达到正常。结论隔日使用激素的PNS患儿也会存在肾上腺皮质功能低下,评价为肾上腺皮质功能正常的肾病患儿对ACTH的快速反应较弱,达到正常反应的时间延迟。Objective To discuss adrenal function in children with primary nephrotic syndrome （PNS）. Methods Sev- enteen patients （dose of prednisone 〈 1 mg/kg）with nephrotic syndrome and 7 healthy subjects were enrolled, seventeen patients with PNS were injected ACTH intravenously at 14： 00. After ACTH injection, blood was taken every 10 minutes for a period of lh for measurement of serum cortisol. Adrenal function was evaluated. We adopted cortisol levels of 497 nmol/L or more as normal adrenal response to low dose of ACTH stimulation. Results In healthy group, all subjects showed normal adrenal function. In 17 patients with PNS, 7 subjects showed suboptimal cortisol responses and adrenal function of another 10 cases were normal. Base blood cortisol in PNS group was lower than that in the control group, but no significant difference （P 〉 0.05）. Compared with the control group, serum cortisol level in PNS group was significantly lower at 20,30,50 and 60 minute （P 〈 0.05）. Cortisol levels was over 497 nmol/L at 10min in control group, while it was at 30 minutes in PNS group .seven cases of adrenocortical hypofunction blood cortisol levels were lower than that of nor- mal control group at each time point （P 〈 0.05）.In 10 cases with normal adrenal function, cortisol levels were lower than that of control group at each time point of blood （P 〉 0.05）. Cortisol levels didn＇t achieve nominal function at 10 minutes in PNS group, while cortisol levels were over 497 nmol/L at that point in control group. Conclusion Our data in- dicate that children with PNS receiving alternate day prednisolone have a suboptimal cortisol response, sug- gesting HPA axis suppression.

关 键 词：小剂量ACTH兴奋试验 原发肾病综合征 肾上腺皮质功能 

分 类 号：R72[医药卫生—儿科]