Palmieri Tina L, Levine Seymour, Schonfeld-Warden Nancy, O'Mara Michael S, Greenhalgh David G
Shriners Hospital for Children Northern California, University of California, Sacramento, California 95817, USA.
J Burn Care Res. 2006 Sep-Oct;27(5):742-8. doi: 10.1097/01.BCR.0000238098.43888.07.
The hypothalamic-pituitary-adrenal (HPA) axis is responsible for stress response after injury, yet its function after severe burn injury in children is unclear. The purpose of this study was to define the effects of burn injury on the HPA axis and to evaluate the utility of total serum cortisol in measuring adrenal function in children with major burns in the 2 months after injury. Children ages 0 to 17 years who were admitted within 72 hours to our pediatric burn center with 20% TBSA or greater full-thickness burns were eligible for the study. Serum total cortisol, adrenocorticotropic hormone (ACTH), dehydroepiandrosterone, vasopressin, Pediatric Risk of Mortality (PRISM) score, serum albumin level, and electrolytes were obtained on admission and weekly for 8 weeks. An ACTH stimulation test (250 microg for children >2 years, 125 microg for children < or =2 years) was administered weekly at 8:00 am. Total serum cortisol was measured before and 60 minutes after the administration of ACTH. Twenty-five children with mean age 7.6 +/- 1.1 years and TBSA burn 41.8 +/- 3.8% were enrolled in the study. Baseline total serum cortisol was 12.4 +/- 0.7 microg/dl in the 8 weeks after injury and increased to 24.4 +/- 0.8 microg/dl after the administration of ACTH. Cortisol level did not correlate with PRISM score, albumin, vasopressin, ACTH, or mortality. Although the adrenal response to acute and chronic stress is intact after severe burn injury, the ACTH/adrenal feedback loop is disrupted. Random total serum cortisol measurements overestimate adrenal dysfunction; thus, ACTH stimulation testing should be used to assess adrenal function before the administration of exogenous steroids.
下丘脑 - 垂体 - 肾上腺（HPA）轴负责损伤后的应激反应，但其在儿童严重烧伤后的功能尚不清楚。本研究的目的是确定烧伤对HPA轴的影响，并评估伤后2个月内血清总皮质醇在评估重度烧伤儿童肾上腺功能中的作用。0至17岁、伤后72小时内入住我院儿科烧伤中心、烧伤面积达20%或以上全层皮肤烧伤的儿童符合本研究条件。入院时及伤后8周每周检测血清总皮质醇、促肾上腺皮质激素（ACTH）、脱氢表雄酮、血管加压素、小儿死亡风险（PRISM）评分、血清白蛋白水平及电解质。每周上午8点进行一次ACTH刺激试验（2岁以上儿童250μg，2岁及以下儿童125μg）。在注射ACTH前及注射后60分钟测量血清总皮质醇。25名平均年龄为7.6±1.1岁、烧伤面积为41.8±3.8%的儿童纳入本研究。伤后8周内基线血清总皮质醇为12.4±0.7μg/dl，注射ACTH后升至24.4±0.8μg/dl。皮质醇水平与PRISM评分、白蛋白、血管加压素、ACTH或死亡率无关。尽管严重烧伤后肾上腺对急性和慢性应激的反应是完整的，但ACTH/肾上腺反馈回路被破坏。随机检测血清总皮质醇会高估肾上腺功能障碍；因此，在给予外源性类固醇之前应用ACTH刺激试验来评估肾上腺功能。
