预测暴露于长期类固醇治疗的新生儿医源性肾上腺功能不全：皮质醇水平有帮助吗？
Predicting iatrogenic adrenal insufficiency in neonates exposed to prolonged steroid courses: do cortisol levels help?
机构信息
Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA.
Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY, USA.
出版信息
J Perinatol. 2024 Nov;44(11):1658-1662. doi: 10.1038/s41372-024-01996-2. Epub 2024 May 20.
OBJECTIVE
To determine whether random cortisol levels obtained in neonates to assess for secondary adrenal insufficiency (AI) after prolonged steroid exposure are predictive of central AI.
STUDY DESIGN
Data were collected on neonates born 2017-2022 who received ≥10 consecutive days of systemic steroids and had cortisol measured thereafter. Data were then collected on whether those neonates developed signs of AI or had a failed adrenocorticotropic hormone (ACTH) stimulation test.
RESULTS
Of the 71 cortisol levels (in 67 neonates) that were analyzed, there was no difference in cortisol levels between neonates who developed AI (median cortisol level of 6.5 mcg/dl) and those who did not (median of 9.2 mcg/dl), or between those who failed their ACTH stimulation test or passed it, using Wilcoxon ranked sum tests.
CONCLUSION
These findings demonstrate that cortisol levels may not be helpful in identifying AI in neonates exposed to prolonged steroids.
目的
确定在接受长期类固醇暴露后评估继发性肾上腺功能不全 (AI) 时获得的新生儿随机皮质醇水平是否可预测中枢性 AI。
研究设计
收集了 2017-2022 年期间出生且接受了 ≥10 天连续全身类固醇治疗且此后测量了皮质醇的新生儿的数据。然后收集了这些新生儿是否出现 AI 迹象或促肾上腺皮质激素 (ACTH) 刺激试验失败的信息。
结果
在分析的 71 个皮质醇水平（67 名新生儿）中，出现 AI 的新生儿（皮质醇中位数为 6.5 mcg/dl）与未出现 AI 的新生儿（皮质醇中位数为 9.2 mcg/dl）之间，或在 ACTH 刺激试验失败或通过的新生儿之间，使用 Wilcoxon 秩和检验，皮质醇水平没有差异。
结论
这些发现表明，皮质醇水平可能无助于识别暴露于长期类固醇的新生儿中的 AI。
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