Müller B
Clinic of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Basel Petersgraben 4, 4031 Basel, Switzerland.
Ann Endocrinol (Paris). 2007 Sep;68(4):290-8. doi: 10.1016/j.ando.2007.06.006. Epub 2007 Jul 30.
Metabolic disorders and endocrine changes are common and relevant in critically ill patients. Thereby, endocrinopathies, electrolyte or metabolic derangements may either pre-exist or develop, and left unattended, may lead to significant morbidity and mortality. The homeostatic corrections which have emerged in the course of human evolution to cope with the catastrophic events during critical illness involve a complex multisystem endeavour, of which the endocrine contribution is an integral component. Although the repertoire of endocrine changes has been probed in some detail, discerning the vulnerabilities and failures of this system is far more challenging. The ensuing endocrine topics illustrate some of the current issues reflecting attempts to gain an improved insight and clinical outcome for critical illness. Disturbances in glucose and cortisol homeostasis during critical illness are two controversially debated topics in the current literature. The term "hormokine" encompasses the cytokine like behaviour of hormones during inflammation and infections. The concept is based on an ubiquitous expression of calcitonin peptides during sepsis. Adrenomedullin, another member of the calcitonin peptide superfamily, was shown to complement and improve the current prognostic assessment in lower respiratory tract infections. Procalcitonin is the protopye of "hormokine" mediators circulating procalcitonin levels increase several 10,000-fold during sepsis improve the clinical assessment especially of respiratory tract infections and sepsis safely and markedly reduces antibiotic usage in non-bacterial respiratory tract infections and meningitis. Adrenomedullin, another member of the calcitonin peptide superfamily, was shown to complement and improve the current prognostic assessment in lower respiratory tract infections. Hormokines are not only biomarkers of infection. Hormokines are also pivotal inflammatory mediators. Like all mediators, their role during systemic infections is basically beneficial, possibly to combat invading microbes. Yet, with increasing levels they can become harmful for their host. Multiple mechanisms of action were proposed. In several animal models the modulation and neutralization of hormokines during infection was shown to improve survival and thus might open new treatment options for severe infections, especially of the respiratory tract.
代谢紊乱和内分泌变化在重症患者中很常见且具有相关性。因此，内分泌疾病、电解质或代谢紊乱可能在重症患者中预先存在或随后发生，若不加以处理，可能导致显著的发病率和死亡率。在人类进化过程中出现的用于应对危重症期间灾难性事件的稳态调节涉及一个复杂的多系统过程，其中内分泌的作用是不可或缺的一部分。尽管内分泌变化的情况已得到一定程度的详细研究，但识别该系统的脆弱性和功能障碍则更具挑战性。以下的内分泌相关主题阐述了一些当前的问题，反映了为深入了解危重症并改善临床结局所做的努力。危重症期间葡萄糖和皮质醇稳态的紊乱是当前文献中两个备受争议的话题。“激素因子”一词涵盖了激素在炎症和感染期间类似细胞因子的行为。这一概念基于降钙素肽在脓毒症期间的广泛表达。降钙素肽超家族的另一个成员肾上腺髓质素，已被证明可补充并改善下呼吸道感染的当前预后评估。降钙素原是“激素因子”介质的原型，脓毒症期间循环中的降钙素原水平会增加数万倍，可安全且显著地改善尤其是呼吸道感染和脓毒症的临床评估，并大幅减少非细菌性呼吸道感染和脑膜炎中的抗生素使用。降钙素肽超家族的另一个成员肾上腺髓质素，已被证明可补充并改善下呼吸道感染的当前预后评估。激素因子不仅是感染的生物标志物。激素因子也是关键的炎症介质。与所有介质一样，它们在全身感染期间的作用基本上是有益的，可能有助于对抗入侵的微生物。然而，随着其水平的升高，它们可能会对宿主造成伤害。人们提出了多种作用机制。在多个动物模型中，感染期间对激素因子的调节和中和已被证明可提高存活率，因此可能为严重感染，尤其是呼吸道感染，开辟新的治疗选择。
