循环性休克、脓毒症综合征及感染性休克中的性甾体激素。

Sex steroid hormones in circulatory shock, sepsis syndrome, and septic shock.

作者信息

Fourrier F, Jallot A, Leclerc L, Jourdain M, Racadot A, Chagnon J L, Rime A, Chopin C

机构信息

Service de réanimation polyvalente-Hôpital B, C.H.R.U. Lille, France.

出版信息

Circ Shock. 1994 Aug;43(4):171-8.

PMID:7895322

Abstract

METHODS

Estrone (E1), estradiol (E2), testosterone (T), FSH, and LH levels were daily measured during a ten day period in 50 critically ill patients (38 men, 12 post-menopausal women). Patients were separated into four groups: A) no circulatory failure, no sepsis, B) sepsis syndrome without circulatory failure, C) circulatory failure without sepsis syndrome, D) septic shock. Results of hormonal measurements were compared 1) among the 4 groups, 2) between male and female patients, 3) between septic and nonseptic patients. The potential for the infusion of the vasoactive drug dobutamine to induce sex hormonal changes was documented in ten additional septic shock patients by measuring cortisol, E1, and T at base-line and after dobutamine infusion. Changes in active renin and plasma renin activity (PRA) were used as indirect witness of the dobutamine-induced beta 2-stimulation.

RESULTS

A dramatic increase in E1 and E2 levels was observed in women of groups B and D, and only in male patients of group D. In the septic patients, estrogen levels peaked at days 1 and 2 and trended to normal from day 6 after the onset of sepsis, while FSH and LH decreased. No difference was found between survivors and non-survivors. Whatever the group, male patients had low T levels throughout the study. Dobutamine induced a significant increase in active renin levels and a decrease in the regression slope between renin and PRA. Cortisol levels remained normal. No significant change in E1 and T was observed after dobutamine.

CONCLUSIONS

High estrogen levels were specifically observed in patients with sepsis and septic shock, either males or females. Decreased LH and FSH levels were consistent with the negative feed-back effect of high estrogen levels on pituitary secretion. Circulating T levels were decreased in all male patients. We found no correlation between sequential estrogen levels and outcome. These levels were not modified by a dobutamine-induced beta-2 stimulation.

摘要

方法

在10天内每日测量50例危重症患者（38例男性，12例绝经后女性）的雌酮（E1）、雌二醇（E2）、睾酮（T）、促卵泡生成素（FSH）和促黄体生成素（LH）水平。患者被分为四组：A）无循环衰竭，无脓毒症；B）无循环衰竭的脓毒症综合征；C）无脓毒症综合征的循环衰竭；D）感染性休克。对激素测量结果进行了如下比较：1）四组之间；2）男性和女性患者之间；3）脓毒症患者和非脓毒症患者之间。通过在基线和多巴酚丁胺输注后测量皮质醇、E1和T，记录了另外10例感染性休克患者输注血管活性药物多巴酚丁胺诱导性激素变化的可能性。活性肾素和血浆肾素活性（PRA）的变化被用作多巴酚丁胺诱导的β2刺激的间接证据。

结果

在B组和D组的女性以及仅D组的男性患者中观察到E1和E2水平显著升高。在脓毒症患者中，雌激素水平在脓毒症发作后的第1天和第2天达到峰值，并从第6天开始趋于正常，而FSH和LH下降。幸存者和非幸存者之间未发现差异。无论在哪一组，男性患者在整个研究过程中T水平都较低。多巴酚丁胺使活性肾素水平显著升高，肾素与PRA之间的回归斜率降低。皮质醇水平保持正常。多巴酚丁胺输注后，E1和T未观察到显著变化。