Park Sang Hoon, Joo Min Sun, Kim Byoung Hoon, Yoo Ha Na, Kim Sung Eun, Kim Jin Bae, Jang Myoung Kuk, Kim Dong Jun, Lee Myung Seok
Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, South Korea.
Medicine (Baltimore). 2018 Jun;97(26):e11046. doi: 10.1097/MD.0000000000011046.
It is well known that adrenal insufficiency is common in septic shock or hemodynamically unstable patients. But, there is as yet no sufficient clinically significant data about the exact prevalence or differences in the cause of cirrhosis with adrenal insufficiency. To investigate adrenal insufficiency prevalence in hemodynamically stable patients with cirrhosis and determine differences based on cirrhosis severity or etiology.From July 2011 to December 2012, 69 hemodynamically stable patients with cirrhosis without infection admitted at Hallym University Medical Center were enrolled. Adrenal insufficiency was defined as a peak cortisol level < 18 μg/dL, 30 or 60 minutes after 250 μg Synacthen injection.The study included 55 male patients (79.7%), and the mean age was 57.9 ± 12.9 years. Cirrhosis etiology was alcohol consumption, HBV, HCV, both viral and alcohol related, and cryptogenic in 49, 15, 7, 11, 9 patients, respectively. Adrenal insufficiency occurred in 24 patients (34.8%). No differences were found in age, sex, mean arterial pressure, heart rate, HDL, cirrhosis etiology, degree of alcohol consumption, encephalopathy, variceal bleeding history, or hepatocellular carcinoma between patients with or without adrenal insufficiency. Serum albumin level was lower (P < .05), and INR was higher (P < .05) in patients with than in those without adrenal insufficiency. However, multivariate analysis revealed no independent adrenal insufficiency predictor. Significant negative correlations were found between Child-Pugh score and peak cortisol levels (γ=-0.365, P = .008).Adrenal insufficiency was frequent even in hemodynamically stable patients with cirrhosis and tended to be associated with only liver disease severity, being unrelated to cirrhosis etiology.
众所周知，肾上腺功能不全在脓毒症休克或血流动力学不稳定的患者中很常见。但是，关于肝硬化合并肾上腺功能不全的确切患病率或病因差异，目前尚无足够的具有临床意义的数据。为了调查血流动力学稳定的肝硬化患者中肾上腺功能不全的患病率，并根据肝硬化的严重程度或病因确定差异。2011年7月至2012年12月，纳入了69例在韩林大学医学中心住院的无感染的血流动力学稳定的肝硬化患者。肾上腺功能不全定义为注射250μg促肾上腺皮质激素后30或60分钟时皮质醇峰值水平<18μg/dL。该研究包括55例男性患者（79.7%），平均年龄为57.9±12.9岁。肝硬化病因分别为酒精性、乙肝、丙肝、病毒和酒精相关以及隐源性，患者分别为49例、15例、7例、11例、9例。24例患者（34.8%）发生肾上腺功能不全。肾上腺功能不全患者与无肾上腺功能不全患者在年龄、性别、平均动脉压、心率、高密度脂蛋白、肝硬化病因、饮酒程度、肝性脑病、静脉曲张出血史或肝细胞癌方面均未发现差异。肾上腺功能不全患者的血清白蛋白水平较低（P<0.05），国际标准化比值较高（P<0.05）。然而，多变量分析未发现独立的肾上腺功能不全预测因素。发现Child-Pugh评分与皮质醇峰值水平之间存在显著负相关（γ=-0.365，P=0.008）。即使在血流动力学稳定的肝硬化患者中，肾上腺功能不全也很常见，并且往往仅与肝脏疾病严重程度相关，与肝硬化病因无关。
