Bilavsky Efraim, Dagan Adi, Yarden-Bilavsky Havatzelet, Davidovits Miriam, Shapiro Rivka, Mor Eytan, Weintrob Naomi, Amir Jacob, Avitzur Yaron
Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tiqva, Israel.
Pediatr Transplant. 2011 May;15(3):314-20. doi: 10.1111/j.1399-3046.2010.01466.x. Epub 2011 Mar 28.
The aim of this study was to assess the prevalence and risk factors of AI in pediatric recipients of kidney or liver transplantation admitted because of a physiological stress episode and to identify patients that might be at risk of adrenal crises by clinical and laboratory parameters at admission. Adrenal function was prospectively evaluated by a standard (250 μg) adrenocorticotropin test in 48 recipients. Data on clinical and laboratory parameters were collected. AI was diagnosed in 11 patients: 10/32 (31.3%) children on long-term steroid treatment and 1/16 (6.25%) untreated. The only risk factor for AI was corticosteroids cumulative dose of >0.15 mg/kg/day during the last six months (p = 0.02, OR 6.67; 95% CI: 0.97-45.79). No correlation was found between clinical or laboratory signs of adrenal crisis on admission and the presence of AI. None of the patients with AI who did not receive stress dose (n = 8) developed adrenal crisis. AI is relatively common in children receiving prolonged corticosteroid treatment after kidney or liver transplantation. Clinical parameters on admission could not reliably identify patients with AI. Universal administration of a stress dose during physiological stress might not be required. However, at this point, the only method to identify patients that will benefit from a stress dose is through the ACTH test.
本研究的目的是评估因生理应激发作而入院的儿童肾移植或肝移植受者中肾上腺功能不全（AI）的患病率和危险因素，并通过入院时的临床和实验室参数识别可能有肾上腺危象风险的患者。对48名受者采用标准（250μg）促肾上腺皮质激素试验对肾上腺功能进行前瞻性评估。收集临床和实验室参数数据。11例患者诊断为AI：32例长期接受类固醇治疗的儿童中有10例（31.3%），16例未接受治疗的儿童中有1例（6.25%）。AI的唯一危险因素是过去6个月内皮质类固醇累积剂量>0.15mg/kg/天（p = 0.02，OR 6.67；95%CI：0.97 - 45.79）。入院时肾上腺危象的临床或实验室体征与AI的存在之间未发现相关性。未接受应激剂量的AI患者（n = 8）均未发生肾上腺危象。AI在肾移植或肝移植后接受长期皮质类固醇治疗的儿童中相对常见。入院时的临床参数不能可靠地识别AI患者。在生理应激期间可能不需要普遍给予应激剂量。然而，目前识别将从应激剂量中获益的患者的唯一方法是通过促肾上腺皮质激素试验。
