脓毒性休克患儿血清皮质醇和促肾上腺皮质激素水平的变化及临床意义  

Changes in serum cortisol and adrenocorticotropic hormone in children with sepsis shock and their clinical significance

作　　者：林海[1] 王子敬[1] 王世彪[1] 康育兰[1] 

机构地区：[1]福建省妇幼保健院PICU/福建医科大学教学医院,福建福州350001

出　　处：《中国当代儿科杂志》2016年第10期1009-1012,共4页Chinese Journal of Contemporary Pediatrics

基　　金：福建省自然科学基金资助项目(2014J01400);福建省妇幼保健院院内科研课题资助项目(13-32)

摘　　要：目的研究脓毒性休克(SS)患儿血清皮质醇和促肾上腺皮质激素(ACTH)水平的动态变化,探讨其与病情严重程度及预后的关系。方法 25例SS失代偿期及24例SS早期患儿纳入研究。检测患儿入院时、入院第3天、入院第8天的血清皮质醇和ACTH水平。25例健康体检小儿作为正常对照组。SS失代偿期组患儿根据其转归分为死亡组(n=5)与存活组(n=20)两个亚组。结果入院时SS失代偿期组和SS早期组血清皮质醇和ACTH水平均明显高于正常对照组(P<0.05),SS失代偿期组两指标水平高于SS早期组(P<0.05);入院第3天SS失代偿期组两指标水平均高于SS早期组和正常对照组(P<0.05),SS早期组的ACTH水平高于正常对照组(P<0.05)。SS失代偿期组患儿中,死亡亚组入院时的血清皮质醇及ACTH水平均显著高于存活亚组(P<0.01);入院第3天,死亡亚组血清皮质醇水平仍显著高于存活亚组(P<0.01)。结论 SS患儿血清皮质醇、ACTH水平增高,其水平的增高与患儿病情有关,持续高水平的血清皮质醇提示预后差,因此,动态监测SS患儿的血清皮质醇、ACTH对判断病情的严重程度及预后具有较高的临床价值。ObjectiveTo study the changes in serum levels of cortisol and adrenocorticotropic hormone （ACTH） in children with septic shock （SS） and to explore their relationship with the disease severity and prognosis.Methods Twenty-ifve children with decompensated SS and 24 children with early SS were enrolled. Serum cortisol and ACTH levels were determined on admission and days 3 and 8 after admission. Twenty-five healthy children were used as the control group. The children with decompensated SS were further divided into death group （n=5） and survival group （n=20） based on their clinical outcome.ResultsOn admission, the decompensated SS and early SS groups had signiifcantly higher serum cortisol and ACTH levels than the control group （P〈0.05）, and the decompensated SS group had signiifcantly higher serum cortisol and ACTH levels than the early SS group. On day 3 after admission, the decompensated SS group had signiifcantly higher serum cortisol and ACTH levels than the early SS and control groups （P〈0.05）, and the early SS group had a signiifcantly higher serum ACTH level than the control group （P〈0.05）. Among the children with decompensated SS, the death group had significantly higher serum cortisol and ACTH levels than the survival group on admission （P〈0.01）; on day 3 after admission, the death group still had a significantly higher serum cortisol level than the survival group （P〈0.01）.ConclusionsChildren with SS have increased serum cortisol and ACTH levels, which are associated with the disease severity. A persistent high serum cortisol level indicates a poor prognosis. Dynamic monitoring of serum cortisol and ACTH levels in children with SS is of great signiifcance in evaluating the disease severity and prognosis.

关 键 词：脓毒性休克 皮质醇 促肾上腺皮质激素 预后 儿童 

分 类 号：R720.597[医药卫生—急诊医学]