Spratt D I, Cox P, Orav J, Moloney J, Bigos T
Department of Medicine, Maine Medical Center, Portland 04102.
J Clin Endocrinol Metab. 1993 Jun;76(6):1548-54. doi: 10.1210/jcem.76.6.8501163.
Changes in the adrenal and thyroid axes in critically ill patients are accentuated by increasing disease severity. However, the relationship of gonadal axis suppression to severity of illness is not well defined. We evaluated serial serum levels of LH, FSH, and testosterone (T) in 59 men and 42 postmenopausal women admitted to critical care units with a spectrum of disease severity. Patients were grouped according to severity of illness by the Acute Physiologic and Chronic Health Evaluation II (APACHE II) scores and by survival. Patients with surgery, renal or hepatic failure, alcohol abuse, endocrine disease, or head trauma were excluded to avoid these confounding factors. In men, mean admission serum T levels in all groups were lower than in healthy controls (P < 0.005). In addition, T levels in men with severe illness (APACHE > 15) were lower than in men with relatively mild (APACHE < 10; P < 0.01) or moderate illness (APACHE 10-15; P < 0.05). These differences were accentuated as hospitalization progressed. In postmenopausal women and men, nadir serum FSH but not LH levels during hospitalization were lower in patients with APACHE greater than 15 than in patients with APACHE scores of 10-15 or less than 15 (P < 0.05). Grouping patients by survival yielded similar results. Analysis of drug effects, age, and PRL did not explain these relationships. We conclude that the degree of both central and peripheral suppression of the reproductive axis in acute illness is related to disease severity. This suppression could not be attributed to other factors known to alter the reproductive axis independently from critical illness (e.g. age, drugs, head trauma, hepatic failure, etc.). These findings further document a general endocrine response to acute illness involving several axes which is graded according to disease severity.
危重病患者肾上腺和甲状腺轴的变化会随着疾病严重程度的增加而加剧。然而，性腺轴抑制与疾病严重程度之间的关系尚未明确界定。我们评估了59名男性和42名绝经后女性的促黄体生成素（LH）、促卵泡生成素（FSH）和睾酮（T）的系列血清水平，这些患者因不同疾病严重程度入住重症监护病房。根据急性生理与慢性健康状况评分系统II（APACHE II）评分和生存情况，将患者按疾病严重程度分组。排除接受手术、患有肾或肝功能衰竭、酗酒、内分泌疾病或头部外伤的患者，以避免这些混杂因素。在男性中，所有组的平均入院血清T水平均低于健康对照组（P < 0.005）。此外，重症男性（APACHE > 15）的T水平低于病情相对较轻（APACHE < 10；P < 0.01）或中度病情（APACHE 10 - 15；P < 0.05）的男性。随着住院时间的延长，这些差异更加明显。在绝经后女性和男性中，APACHE大于15的患者住院期间血清FSH的最低点低于APACHE评分为10 - 15或小于15的患者，但LH水平无此差异（P < 0.05）。按生存情况对患者进行分组也得出了类似结果。对药物作用、年龄和泌乳素的分析并不能解释这些关系。我们得出结论，急性疾病中生殖轴的中枢和外周抑制程度与疾病严重程度相关。这种抑制不能归因于已知独立于危重病改变生殖轴的其他因素（如年龄、药物、头部外伤、肝功能衰竭等）。这些发现进一步证明了急性疾病涉及多个轴的一般内分泌反应，该反应根据疾病严重程度分级。
