机械通气脓毒症患者微透析获得的间质皮质醇：与总血清皮质醇和游离血清皮质醇的相关性。

Interstitial cortisol obtained by microdialysis in mechanically ventilated septic patients: correlations with total and free serum cortisol.

机构信息

Endocrine Unit, Second Department of Internal Medicine-Research Institute and Diabetes Center, Attikon University Hospital, Athens, Greece.

出版信息

J Crit Care. 2013 Apr;28(2):158-65. doi: 10.1016/j.jcrc.2012.07.008. Epub 2012 Sep 13.

DOI:10.1016/j.jcrc.2012.07.008

PMID:22981531

Abstract

PURPOSE

The aim of this study was to measure subcutaneous tissue cortisol obtained by microdialysis (MD) in 35 mechanically ventilated septic patients.

MATERIALS AND METHODS

Upon intensive care unit admission, an MD catheter was inserted into the subcutaneous tissue of the thigh. Cortisol (CORT) was determined in a 5:00 to 9:00 am microdialysate sample collected within 72 hours. Concurrently, serum total (T-CORT) and free CORT (F-CORT) were measured. The Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment scores were calculated. Both T-CORT less than 10 μg/dL and F-CORT less than 0.8 μg/dL were considered as indicating critical illness-related corticosteroid insufficiency. Adrenal adequacy was defined as T-CORT greater than 20 μg/dL or F-CORT greater than 2.0 μg/dL.

RESULTS

Total CORT correlated significantly with F-CORT (rs = +0.8, P < .0001). Microdialysis CORT had a lower correlation with T-CORT (rs = +0.6, P < .0001) and F-CORT (rs = +0.7, P < .0001) and a weak correlation with APACHE II score (rs = +0.4, P < .01). On the basis of MD-CORT, the patients were divided in quartiles. Although the median F-CORT and T-CORT levels were significantly different (P < .001) among the MD-CORT quartiles, there was a considerable overlap between the subgroups. All patients with T-CORT less than 10 μg/dL and all but 3 patients with F-CORT less than 0.8 μg/dL had tissue CORT in the lower quartile. However, only 50% and 58% of patients with adequate T-CORT and F-CORT levels, respectively, had concordant MD-CORT in the highest quartile.

CONCLUSIONS

Microdialysis CORT levels correlate moderately with circulating T-CORT and F-CORT. Of note, several patients presented with discrepant measurements between interstitial and circulating CORT concentrations. Thus, interstitial CORT measurements represent an additional tool to investigate the tissue CORT availability in critically ill patients.

摘要

目的

本研究旨在测量 35 例机械通气脓毒症患者的皮下组织通过微透析（MD）获得的皮质醇。

材料和方法

入住重症监护病房时，将 MD 导管插入大腿的皮下组织。在 72 小时内采集 5:00 至 9:00 am 的微透析样本，以确定皮质醇（CORT）。同时测量血清总（T-CORT）和游离皮质醇（F-CORT）。计算急性生理学和慢性健康评估（APACHE II）和序贯器官衰竭评估评分。T-CORT 小于 10μg/dL 和 F-CORT 小于 0.8μg/dL 均被认为表明与危重病相关的皮质激素不足。肾上腺功能正常定义为 T-CORT 大于 20μg/dL 或 F-CORT 大于 2.0μg/dL。

结果

总 CORT 与 F-CORT 呈显著正相关（rs = +0.8，P<.0001）。MD-CORT 与 T-CORT（rs = +0.6，P<.0001）和 F-CORT（rs = +0.7，P<.0001）的相关性较低，与 APACHE II 评分的相关性较弱（rs = +0.4，P<.01）。根据 MD-CORT，患者被分为四分位数。尽管 MD-CORT 四分位数的 F-CORT 和 T-CORT 水平存在显著差异（P<.001），但亚组之间存在相当大的重叠。所有 T-CORT 小于 10μg/dL 的患者和所有 F-CORT 小于 0.8μg/dL 的患者但有 3 例除外，其组织 CORT 均处于较低四分位数。然而，仅有 50%和 58%分别具有足够 T-CORT 和 F-CORT 水平的患者，其 MD-CORT 在最高四分位数中具有一致性。