Dimopoulou Ioanna, Ilias Ioannis, Roussou Paraskevi, Gavala Alexandra, Malefaki Adigoni, Milou Ema, Pitaridis Marinos, Roussos Charis
Department of Critical Care Medicine, Evangelismos Hospital, Medical School, National & Kapodistrian University of Athens, Greece.
Intensive Care Med. 2002 Aug;28(8):1168-71. doi: 10.1007/s00134-002-1360-0. Epub 2002 Jul 6.
To investigate the adrenal function in non-septic, long-stay critically ill patients.
Prospective, consecutive study.
General intensive care unit in a university hospital.
Forty-three non-septic patients with protracted critical illness.
A morning blood sample was first obtained to measure baseline plasma cortisol. Subsequently, 1 micro g of corticotropin (ACTH, Synacthene) was injected intravenously and 30 min later a second blood sample was drawn to determine stimulated plasma cortisol. Patients having a stimulated cortisol level of at least 18 micro g/dl were defined as responders. In 36 patients, morning interleukin-6 (IL-6) was also measured.
Baseline and stimulated plasma cortisol were 16.8+/-4.1 micro g/dl and 21.2+/-5.1 micro g/dl, respectively. Interleukin-6 was high (median 39.3 pg/ml, interquartile range 24.9-86.6 pg/ml) and correlated negatively with stimulated plasma cortisol (r=-0.40, p<0.05). Of the 43 patients studied, 31 patients (72%) were responders and 12 patients (28%) were non-responders to the ACTH stimulation test. Overall, 18 patients died and 25 patients survived to hospital discharge. Non-responders had significantly higher IL-6 levels compared to responders (106+/-73 versus 48+/-42 pg/ml, p<0.05), whereas mortality rate was comparable in the two groups (50% versus 38%, p=0.74).
Circulating plasma IL-6 levels are high during protracted critical illness, and are partially responsible for the relative adrenal insufficiency found in a subset of severely ill patients.
研究非脓毒症、长期住院的危重症患者的肾上腺功能。
前瞻性连续研究。
大学医院的综合重症监护病房。
43例患有持续性危重症的非脓毒症患者。
首先采集一份早晨血样以测定基础血浆皮质醇。随后，静脉注射1微克促肾上腺皮质激素（ACTH，辛纳科辛），30分钟后采集第二份血样以测定刺激后的血浆皮质醇。刺激后皮质醇水平至少为18微克/分升的患者被定义为反应者。在36例患者中，还测定了早晨的白细胞介素-6（IL-6）。
基础血浆皮质醇和刺激后血浆皮质醇分别为16.8±4.1微克/分升和21.2±5.1微克/分升。白细胞介素-6水平较高（中位数39.3皮克/毫升，四分位间距24.9 - 86.6皮克/毫升），且与刺激后血浆皮质醇呈负相关（r = -0.40，p < 0.05）。在研究的43例患者中，31例患者（72%）对ACTH刺激试验有反应，12例患者（28%）无反应。总体而言，18例患者死亡，25例患者存活至出院。无反应者的IL-6水平显著高于有反应者（106±73皮克/毫升对48±42皮克/毫升，p < 0.05），而两组的死亡率相当（50%对38%，p = 0.74）。
在持续性危重症期间，循环血浆IL-6水平较高，部分导致了一部分重症患者出现的相对肾上腺功能不全。
