Slowik Agnieszka, Turaj Wojciech, Pankiewicz Joanna, Dziedzic Tomasz, Szermer Paweł, Szczudlik Andrzej
Stroke Unit, Department of Neurology, Collegium Medicum, Jagiellonian University, Botaniczna 3 31-503, Krakow, Poland.
J Neurol Sci. 2002 Apr 15;196(1-2):27-32. doi: 10.1016/s0022-510x(02)00018-7.
Hypercortisolemia is thought to be a marker of the stress response following stroke. The aim of this study was to investigate the prevalence and prognostic significance of hypercortisolemia. The circadian variation of cortisol level and the relationship between serum cortisol levels and other stress, inflammatory, and haemostatic markers were also investigated. Seventy consecutive patients with their first ischemic stroke and 24 age- and sex-matched controls were included in the study. Serum cortisol levels (at 6:00 AM, 10:00 AM, 6:00 PM, and 10:00 PM), 24-h urine catecholamine excretion, beta-thromboglobulin levels, and other standard biochemical and haematological parameters were measured on the first day of hospitalisation and in control subjects. Outcome measures used the Barthel Index at Day 30, as well as 30- and 90-day mortality rates. Hypercortisolemia, defined as at least two of the four measurements above the normal range of serum cortisol levels (i.e. >618 nmol/l from the morning samples and >460 nmol/l from the evening samples) was found in 25 (35.7%) of the acute stroke patients and in 3 (12.5%) of the controls (p<0.05). Hypercortisolemia was associated with older age, greater severity of neurological deficit, larger ischemic lesions on CT, and worse prognoses (p<0.05). The study did not find a correlation between serum cortisol levels and other markers of the stress response such as catecholamines excretion and glucose levels. A significant correlation between serum cortisol levels and some markers of the inflammatory response, such as fever, fibrinogen level, white blood cell (WBC) count, and beta-thromboglobulin level, was established in stroke patients. Prognostic significance of hypercortisolemia in acute stroke patients seems to be related to the inflammatory response rather than to the stress response.
高皮质醇血症被认为是卒中后应激反应的一个标志物。本研究的目的是调查高皮质醇血症的患病率及其预后意义。同时还研究了皮质醇水平的昼夜变化以及血清皮质醇水平与其他应激、炎症和止血标志物之间的关系。该研究纳入了70例首次发生缺血性卒中的连续患者以及24例年龄和性别匹配的对照者。在住院第一天对患者和对照者测量血清皮质醇水平（上午6:00、上午10:00、下午6:00和晚上10:00）、24小时尿儿茶酚胺排泄量、β-血小板球蛋白水平以及其他标准生化和血液学参数。结局指标采用第30天的巴氏指数以及30天和90天死亡率。高皮质醇血症定义为上述四项测量中至少两项高于血清皮质醇水平正常范围（即上午样本>618 nmol/l，晚上样本>460 nmol/l），在2�例（35.7%）急性卒中患者和3例（12.5%）对照者中发现高皮质醇血症（p<0.05）。高皮质醇血症与年龄较大、神经功能缺损更严重、CT上缺血性病灶更大以及预后较差相关（p<0.05）。该研究未发现血清皮质醇水平与其他应激反应标志物如儿茶酚胺排泄量和血糖水平之间存在相关性。在卒中患者中，血清皮质醇水平与一些炎症反应标志物如发热、纤维蛋白原水平、白细胞（WBC）计数和β-血小板球蛋白水平之间存在显著相关性。急性卒中患者高皮质醇血症的预后意义似乎与炎症反应而非应激反应有关。
