重症手足口病患儿血清皮质醇与甲状腺激素的变化特点  

The investigation of changes in serum cortisol and thyroid hormone in children with severe hand, foot and mouth disease

作　　者：熊妍妍[1] 徐南平[1] 李轶[2] 卢娟[3] 胡玉[1] Xiong Yah-yan Xu Nan-ping Li Yi Lu Juan Hu Yu(Emergency Centre, fiangxi Provincial Children＇s Hospital, Nanchang 330006, Chin)

机构地区：[1]江西省儿童医院急诊中心,江西南昌330006 [2]南昌大学医学院,江西南昌330038 [3]江西省儿童医院检验科,江西南昌330006

出　　处：《中国急救医学》2017年第1期69-75,共7页Chinese Journal of Critical Care Medicine

基　　金：江西省卫生厅科技项目（20114018）

摘　　要：目的探讨重症手足口病患儿的血清皮质醇（COR）、促肾上皮质激素（ACTH）和甲状腺素的变化特点，为临床重症手足口病的早期评估和激素的合理使用提供参考。方法选择2014—03 - 2015—06人江西省儿童医院急诊病房和PICU住院的重症手足口病患儿90例，按照临床分期标准分为三组，A组（2期）、B组（3期）、C组（4期）各30例。入院后次日清晨空腹抽取静脉血，采用化学发光检测法分别测定三组患儿的血清COR、ACTH和甲状腺素水平。结果①2、3、4期重症手足口病患儿的COR水平均高于正常值，4期重症手足口病患儿的ACTH、COR水平明显高于2、3期患儿（P〈0．05）；②2、3、4期重症手足口病患儿的游离三碘甲状腺素原氨酸（FT3）水平均低于正常值，且3、4期重症手足口病患儿的游离甲状腺素（FT4）和促甲状腺激素（TSH）水平明显低于2期患儿（P〈0．05）；③随着三期重症手足口病患儿的血清COR、ACTH水平升高及甲状腺激素水平的下降，患儿的住院天数、发热持续时间、机械通气时间和血压恢复正常的时间明显延长，治愈率降低。④71．11％重症手足12病患儿可合并甲状腺功能正常的病态综合征（ESS）；⑤使用糖皮质激素治疗后的2期、3期、4期患儿发热天数明显短于未使用激素治疗组（P〈0．05）；但2、3期的大剂量激素[10 - 15mg／（kg·d）]治疗组与小剂量激素[1～2mg／（kg·d）]治疗组及未使用激素治疗组的住院天数、惊跳持续时间、治愈好转率比较差异无统计学意义（P〉0．05）。⑥虽然4期大剂量激素治疗组与小剂量激素组的住院天数、惊跳持续时间比较差异无统计学意义（P〉0．05），但4期小剂量激素组的治愈率高于大剂量激素组（P〈0．05）。结论①重症手足口病患儿的病情越重，ACTH和COR水平越高，FT3、FT4、TSH水平越低；②糖皮质激素使用可缩短Objective To investigate the changes in serum cortisol （COR）, adrenocorticotropic hormone （ACTH） and thyroid hormone （TH） of children with severe hand- foot- and- mouth disease （HFMD）, and provide references for early assessment and rational use glucocorticoid in critical patients with severe HFMD. Methods Ninety patients with severe HFMD hospitalized in emergency ward （HFMD ward） and PICU of Jiangxi Children＇s Hospital were selected from March 2014 to June 2015. According to 2011 version of the expert consensus of clinical staging criteria, the patients were divided into three groups： group A （stage 2）, group B （stage 3）and group C （stage d）; there were 30 cases in each group. The next morning after admission, fasting venous blood was taken and the levels of COR, ACTH and TH in 3 groups were measured by chemiluminescence immunoassay. Results （1）The COR levels of children with severe HFMD in stage 2, 3 and 4 were higher than normal value （4.3 - 22.41 μg/dL）; the COR and ACTH levels of children in stage 4 were significantly higher than that of children in stage 2 and 3; the difference was statistically significant （P 〈 0.05）. （2）The levels of free three iodine thyroid original ammonia acid （FT3） in children with HFMD in stage 2, 3 and g were lower than normal value （3.37 - 7.98 pg/mL）, and the free thyroxine （FT4） and thyroid stimulating hormone （TSH） levels in stages 3 and 4 of children with HFMD were lower than that of stage 2 （P 〈 0.05）. （3）With serum COR and ACTH levels of children in different stages increased, and the level of thyroid hormone decreased; the length of hospital stay, duration of fever, duration of mechanical ventilation and blood pressure recovery time were significantly prolonged; and the cure rate was reduced. （4）71.11% of severe HFMD children complicated with euthyroid sick syndrome （ESS）. （5）The duration of fever of children with glucocorticoid therapy in stages 2, 3 and 4 were significantly shorte

关 键 词：手足口病 临床分期 皮质醇(COR) 促肾上皮质激素(ACTH) 甲状腺激素 

分 类 号：R591.1[医药卫生—内科学]