Onenli-Mungan N, Yildizdas D, Yapicioglu H, Topaloglu A K, Yüksel B, Ozer G
Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey.
J Paediatr Child Health. 2004 Apr;40(4):221-6. doi: 10.1111/j.1440-1754.2004.00342.x.
Despite improved supportive care, the mortality of sepsis and septic shock is still high. Multiple changes in the neuroendocrine systems, at least in part, are responsible for the high morbidity and mortality. A reduced circulating level of insulin-like growth factor and an elevated level of growth hormone are the reported characteristic findings early in the course of sepsis and septic shock in adults. The aim of this study was to evaluate the changes of growth hormone/insulin-like growth factor 1 axis in sepsis and septic shock and investigate the relationship between these hormones and survival.
Fifty-one children with sepsis (S), 21 children with septic shock (SS) and 30 healthy, age- and sex-matched children (C) were enrolled in this study. Growth hormone, insulin-like growth factor 1 and cortisol levels of the sepsis and septic shock groups were obtained before administration of any inotropic agent.
Growth hormone levels were 32.3 +/- 1.5 microIU/mL (range 4-56), 15.9 +/- 0.6 microIU/mL (range 11-28) and 55.7 +/- 2.7 microIU/mL (range 20-70) in S, C and SS groups, respectively. The difference between the growth hormone levels of the S and C groups, S and SS groups, and C and SS groups were significant (P < 0.001). Non-survivors (54.7 +/- 1.6 microIU/mL) had significantly higher growth hormone levels than survivors (29.4 +/- 1.5 microIU/mL) (P < 0.001). Insulin-like growth factor 1 levels were 38.1 +/- 2.1 ng/mL (range 19-100), 122.9 +/- 9.6 ng/mL (range 48-250) and 22.2 +/- 1.9 ng/mL (range 10-46) in the S, C and SS groups, respectively, and the difference between the insulin-like growth factor 1 levels of the S and C, S and SS, and C and SS groups were significant (P < 0.001). Non-survivors (8.8 +/- 1.1 micro g/dL) had significantly lower cortisol levels than survivors (40.9 +/- 2.1 microg/dL) (P < 0.001). We detected a significant difference between the levels of cortisol in non-survivors (19.7 +/- 1.8 microg/dL) and survivors (33.9 +/- 0.9 microg/dL) (P < 0.01).
There were elevated levels of growth hormone with decreased levels of insulin-like growth factor 1 in children during sepsis and septic shock compared to healthy subjects. In addition, there were even higher levels of growth hormone and lower levels of insulin-like growth factor 1 in non-survivors than in survivors. We think that both growth hormone and insulin-like growth factor 1 may have potential prognostic value to serve as a marker in bacterial sepsis and septic shock in children. As there is insufficient data in the paediatric age group, more studies including large numbers of patients and additionally evaluating cytokines and insulin-like growth factor binding proteins are needed.
尽管支持治疗有所改善，但脓毒症和脓毒性休克的死亡率仍然很高。神经内分泌系统的多种变化至少部分导致了高发病率和死亡率。据报道，在成人脓毒症和脓毒性休克病程早期，胰岛素样生长因子循环水平降低以及生长激素水平升高是其特征性表现。本研究的目的是评估脓毒症和脓毒性休克中生长激素/胰岛素样生长因子1轴的变化，并研究这些激素与生存率之间的关系。
本研究纳入了51例脓毒症患儿（S组）、21例脓毒性休克患儿（SS组）和30例年龄及性别匹配的健康儿童（C组）。在给予任何血管活性药物之前，获取脓毒症组和脓毒性休克组患儿的生长激素、胰岛素样生长因子1和皮质醇水平。
S组、C组和SS组的生长激素水平分别为32.3±1.5微国际单位/毫升（范围4 - 56）、15.9±0.6微国际单位/毫升（范围11 - 28）和55.7±2.7微国际单位/毫升（范围20 - 70）。S组与C组、S组与SS组以及C组与SS组之间的生长激素水平差异均有统计学意义（P < 0.001）。非存活者（54.7±1.6微国际单位/毫升）的生长激素水平显著高于存活者（29.4±1.5微国际单位/毫升）（P < 0.001）。S组、C组和SS组的胰岛素样生长因子1水平分别为38.1±2.1纳克/毫升（范围19 - 100）、122.9±9.6纳克/毫升（范围48 - 250）和22.2±1.9纳克/毫升（范围10 - 46），S组与C组、S组与SS组以及C组与SS组之间的胰岛素样生长因子1水平差异均有统计学意义（P < 0.001）。非存活者（8.8±1.1微克/分升）的皮质醇水平显著低于存活者（40.9±2.1微克/分升）（P < 0.001）。我们检测到非存活者（19.7±1.8微克/分升）和存活者（33.9±0.9微克/分升）的皮质醇水平存在显著差异（P < 0.01）。
与健康受试者相比，脓毒症和脓毒性休克患儿的生长激素水平升高，胰岛素样生长因子1水平降低。此外，非存活者的生长激素水平比存活者更高，胰岛素样生长因子1水平更低。我们认为生长激素和胰岛素样生长因子1都可能具有潜在的预后价值，可作为儿童细菌性脓毒症和脓毒性休克的标志物。由于儿科年龄组的数据不足，需要更多包括大量患者的研究，并进一步评估细胞因子和胰岛素样生长因子结合蛋白。
