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30 周以上胎龄早产儿尿糖皮质激素类固醇排泄率测定肾上腺功能成熟度。

Maturation of adrenal function determined by urinary glucocorticoid steroid excretion rates in preterm infants of more than 30 weeks of gestational age.

机构信息

Department of General Pediatrics and Neonatology, Justus Liebig University, Giessen, Germany.

出版信息

Neonatology. 2010;98(2):200-5. doi: 10.1159/000285571. Epub 2010 Mar 16.

Abstract

BACKGROUND

Data on the adrenal stress response of preterm infants between 30 and 36 weeks are inconsistent.

OBJECTIVE

To test the hypothesis that there is a positive association between illness severity and cortisol production rates (CPR) in preterm infants >30 weeks.

PATIENTS AND METHODS

In a prospective longitudinal observational study, glucocorticoid metabolites were profiled by gas chromatography-mass spectrometry in 24-hour urinary samples. Excretion rates of glucocorticoid metabolites were summed to calculate CPR in 61 well (mean +/- SD: 33.6 +/- 1.7 weeks) and 20 ill (33.2 +/- 1.6 weeks) preterm infants. Illness severity was measured by the score for neonatal acute physiology (SNAP).

RESULTS

During the first week of life, SNAP were higher in the group of ill compared to well infants. Medians of CPR (microg/kg/d per mg creatinine) in ill (well) infants were: 1st day, 31 (28); 2nd day, 24 (28); 3rd day, 27 (26); 5th day, 28 (17); 2nd week, 20 (19); 3rd week, 17 (19); 4th week, 16 (16); and 2nd month, 17 (23). There was a significant association between the maximum of SNAP and the maximum of CPR (OR 3.7; 95% CI: 1.2-11.5; p = 0.02) in a logistic regression model which comprised gestational age, mode of delivery, gender and the administration of prenatal steroids as covariables.

CONCLUSION

There was a positive association between severity of illness and CPR in preterm infants >30 weeks, indicating a maturation of the adrenal stress response.

摘要

背景

关于 30 至 36 周早产儿肾上腺应激反应的数据不一致。

目的

检验假设,即在 >30 周的早产儿中,疾病严重程度与皮质醇产生率(CPR)之间存在正相关。

患者和方法

在一项前瞻性纵向观察研究中,通过气相色谱-质谱法对 24 小时尿液样本中的糖皮质激素代谢物进行分析。将糖皮质激素代谢物的排泄率相加,以计算 61 名健康(平均 +/- SD:33.6 +/- 1.7 周)和 20 名患病(33.2 +/- 1.6 周)早产儿的 CPR。疾病严重程度通过新生儿急性生理学评分(SNAP)进行测量。

结果

在生命的第一周,患病组的 SNAP 高于健康组。患病(健康)婴儿的 CPR(mg/kg/d 每 mg 肌酐)中位数分别为:第 1 天,31(28);第 2 天,24(28);第 3 天,27(26);第 5 天,28(17);第 2 周,20(19);第 3 周,17(19);第 4 周,16(16);第 2 个月,17(23)。在包含胎龄、分娩方式、性别和产前类固醇给药作为协变量的逻辑回归模型中,SNAP 的最大值与 CPR 的最大值之间存在显著相关性(OR 3.7;95%CI:1.2-11.5;p = 0.02)。

结论

在 >30 周的早产儿中,疾病严重程度与 CPR 之间存在正相关,表明肾上腺应激反应的成熟。

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