Ng P C, Lee C H, Lam C W K, Ma K C, Chan I H S, Wong E, Fok T F
Department of Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, NT.
Arch Dis Child Fetal Neonatal Ed. 2004 Mar;89(2):F127-30. doi: 10.1136/adc.2002.021980.
To assess the influence of circulating (basal) and stimulated plasma adrenocorticotrophin (ACTH) and serum cortisol on the duration of oxygen supplementation and development of chronic lung disease (CLD) in preterm, very low birthweight infants.
A total of 226 human corticotrophin releasing hormone stimulation tests were performed on 137 very low birthweight infants on days 7 and 14 in a tertiary neonatal centre.
Multivariate regression analysis showed that the duration of oxygen supplementation was negatively associated with birth weight, but positively associated with alveolar-arterial oxygen gradient (A-aDO(2)) on the first day and with basal serum cortisol on day 14. In addition, the multivariate classification and regression trees model indicated that the two most useful indices for predicting CLD were clinical risk index for babies (CRIB) score (> 9) and peak serum cortisol (> 740 nmol/l) on day 14. The sensitivity, specificity, positive and negative predictive values of these factors for predicting CLD were 53%, 80%, 81%, and 70% respectively.
The findings suggest that birth weight, severity of initial respiratory failure as reflected by the A-aDO(2) gradient, and continuing "stress" with persistent increase in serum cortisol on day 14 are significant risk factors associated with the duration of oxygen supplementation, whereas early pituitary-adrenal response (basal and peak plasma ACTH and serum cortisol on day 7) is not an independent risk factor. Although CRIB score in combination with peak serum cortisol on day 14 are useful predictors of CLD, the need to use a stimulation test and the relatively late timing of the forecast render these indices unattractive for routine clinical use.
评估循环（基础）和刺激后的血浆促肾上腺皮质激素（ACTH）及血清皮质醇对早产、极低出生体重儿氧疗持续时间和慢性肺病（CLD）发生发展的影响。
在一家三级新生儿中心，对137例极低出生体重儿在出生第7天和第14天进行了总共226次人促肾上腺皮质激素释放激素刺激试验。
多因素回归分析显示，氧疗持续时间与出生体重呈负相关，但与出生第一天的肺泡 - 动脉氧分压差（A - aDO₂）及第14天的基础血清皮质醇呈正相关。此外，多因素分类回归树模型表明，预测CLD最有用的两个指标是婴儿临床风险指数（CRIB）评分（>9）和第14天的血清皮质醇峰值（>740 nmol/L）。这些因素预测CLD的敏感性、特异性、阳性预测值和阴性预测值分别为53%、80%、81%和70%。
研究结果表明，出生体重、A - aDO₂梯度所反映的初始呼吸衰竭严重程度以及第14天血清皮质醇持续“应激”性持续升高是与氧疗持续时间相关的重要危险因素，而早期垂体 - 肾上腺反应（第7天基础和峰值血浆ACTH及血清皮质醇）不是独立危险因素。虽然CRIB评分与第14天血清皮质醇峰值相结合是CLD的有用预测指标，但使用刺激试验的必要性以及预测时间相对较晚使得这些指标在常规临床应用中缺乏吸引力。
