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

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。

Abstract:

Objective To 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-five 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. Results On admission, the decompensated SS and early SS groups had significantly higher serum cortisol and ACTH levels than the control group (P < 0.05), and the decompensated SS group had significantly higher serum cortisol and ACTH levels than the early SS group. On day 3 after admission, the decompensated SS group had significantly higher serum cortisol and ACTH levels than the early SS and control groups (P < 0.05), and the early SS group had a significantly 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). Conclusions Children 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 significance in evaluating the disease severity and prognosis.