Chiriac Ş, Stanciu C, Negru R, Trifan A
"Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania.
"St. Spiridon" Emergency Hospital - Institute of Gastroenterology and Hepatology, Iaşi, Romania.
Acta Endocrinol (Buchar). 2016 Jul-Sep;12(3):262-267. doi: 10.4183/aeb.2016.262.
Relative adrenal insufficiency (RAI) is common in the setting of critical illness as well as in hemodynamically instable cirrhotic patients with sepsis. Several studies have also shown that RAI is frequent in patients with stable cirrhosis without sepsis. The aim of this study was to prospectively assess the incidence of RAI in patients with stable cirrhosis.
Forty-seven patients with hemodynamically stable liver cirrhosis without sepsis were prospectively included. RAI, assessed by using low dose-short Synacthen test (LD-SST), was defined as either a basal total cortisol concentration below 3.6 µg/dL or a peak total serum cortisol ≤ 16 µg/dL at 30 min after stimulation.
RAI was present in 10 (21.3%) of 47 cirrhotic patients. Peak cortisol level was negatively correlated with the severity of cirrhosis evaluated by Child-Turcotte-Pugh (CTP) (r=-0.46; P=0.001) and Model for End-Stage Liver Disease (MELD) (r=-0.51; P=0.001) scores. The frequency of RAI increased from CTP-A (10%) to CTP-B (30%) to CTP-C (60%).
RAI diagnosed by LD-SST is frequent in patients with stable cirrhosis and is related to the severity of liver disease. Further studies are needed to define clinical importance of RAI in stable cirrhotic patients.
相对肾上腺皮质功能不全（RAI）在危重病患者以及血流动力学不稳定的脓毒症肝硬化患者中很常见。多项研究还表明，在无脓毒症的稳定型肝硬化患者中，RAI也很常见。本研究的目的是前瞻性评估稳定型肝硬化患者中RAI的发生率。
前瞻性纳入47例血流动力学稳定、无脓毒症的肝硬化患者。通过低剂量短程促肾上腺皮质激素试验（LD-SST）评估RAI，其定义为基础总皮质醇浓度低于3.6µg/dL或刺激后30分钟时血清总皮质醇峰值≤16µg/dL。
47例肝硬化患者中有10例（21.3%）存在RAI。皮质醇峰值水平与通过Child-Turcotte-Pugh（CTP）评分（r=-0.46；P=0.001）和终末期肝病模型（MELD）评分（r=-0.51；P=0.001）评估的肝硬化严重程度呈负相关。RAI的发生率从CTP-A级（10%）增加到CTP-B级（30%）再到CTP-C级（60%）。
通过LD-SST诊断的RAI在稳定型肝硬化患者中很常见，且与肝病严重程度相关。需要进一步研究来明确RAI在稳定型肝硬化患者中的临床意义。
