[严重脓毒症和脓毒性休克患者下丘脑-垂体-靶腺轴功能的早期变化]

[Early changes in function of hypothalamic-pituitary-target gland axis in patients with severe sepsis and septic shock].

作者信息

Cui Na, Liu Da-wei, Wang Hao, Zeng Zheng-pei, Long Yun, Chai Wen-zhao, Liu Hong-zhong, Wang Xiao-ting

机构信息

Intensive Care Unit, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100730, China.

出版信息

Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007 Jun;19(6):332-5.

PMID:17577436

Abstract

OBJECTIVE

To investigate the early changes in function of hypothalamic-pituitary-target gland (HPTG) axis in patients with severe sepsis and septic shock, in order to clarify its relationship with severity and prognosis of the patients.

METHODS

The serum contents of cortisol (F), triiodothyronine (T(3)), thyroxine (T(4)), thyrotropic-stimulating hormone (TSH), growth hormone (GH), follicle-stimulating hormone (FSH), luteotropic hormone (LH), prolactin (PRL) and plasma concentration of adrenocorticotrophic hormone (ACTH) in 10 severe sepsis and 12 septic shock patients on day 1, 3, 5 after diagnosis was made, and 12 patients with no infection or septic shock served as controls. The hypothalamic-pituitary adrenal gland axis (HPAA) function of the patients with severe sepsis and septic shock were evaluated with 1 microgram ACTH stimulation test given 1 day after the concentrations of the above hormones were determined.

RESULTS

Compared with the control patients, ACTH, T(3), T(4), GH, FSH, LH and PRL levels were significantly changed in patients with severe sepsis and septic shock (P<0.05 or P<0.01). The numbers of patients with reaction to 1 microgram ACTH stimulation test were similar between patients with severe sepsis (6 cases non-reaction and 3 cases reaction) and patients with septic shock (9 cases non reaction and 2 cases reaction, P>0.05). According to the acute physiology and chronic health evaluation II (APACHE II) and sepsis-related organ failure assessment (SOFA) score, changes in ACTH, T(3), T(4), GH and PRL levels were closely related to the severity of illness (P<0.05 or P<0.01). Significant differences were found in ACTH, T(3), T(4) levels between survivors and non-survivors (P<0.05 or P<0.01). ACTH, T(4) levels and SOFA score were independent predictors of the 28-day hospital mortality (P<0.05 or P<0.01).

CONCLUSION

The early changes in HPTG axis are closely related with the severity and hospital mortality in patients with severe sepsis and septic shock.

摘要

目的

探讨严重脓毒症和脓毒性休克患者下丘脑 - 垂体 - 靶腺（HPTG）轴功能的早期变化，以阐明其与患者病情严重程度及预后的关系。

方法

选取10例严重脓毒症患者和12例脓毒性休克患者，于确诊后第1天、3天、5天检测其血清皮质醇（F）、三碘甲状腺原氨酸（T₃）、甲状腺素（T₄）、促甲状腺激素（TSH）、生长激素（GH）、卵泡刺激素（FSH）、黄体生成素（LH）、催乳素（PRL）的含量及血浆促肾上腺皮质激素（ACTH）浓度，另选12例无感染或脓毒性休克的患者作为对照。在上述激素浓度测定1天后，给予1 μg ACTH刺激试验，评估严重脓毒症和脓毒性休克患者的下丘脑 - 垂体 - 肾上腺轴（HPAA）功能。

结果

与对照组患者相比，严重脓毒症和脓毒性休克患者的ACTH、T₃、T₄、GH、FSH、LH及PRL水平有显著变化（P<0.05或P<0.01）。严重脓毒症患者（6例无反应，3例有反应）和脓毒性休克患者（9例无反应，2例有反应）中，对1 μg ACTH刺激试验有反应的患者数量相似（P>0.05）。根据急性生理与慢性健康状况评分系统II（APACHE II）和脓毒症相关器官功能衰竭评估（SOFA）评分，ACTH、T₃、T₄、GH及PRL水平的变化与疾病严重程度密切相关（P<0.05或P<0.01）。存活者与非存活者的ACTH、T₃、T₄水平存在显著差异（P<0.05或P<0.01）。ACTH、T₄水平及SOFA评分是28天住院死亡率的独立预测因素（P<0.05或P<0.01）。