Vigna L, Buccianti G, Orsatti A, Cresseri D, Bianchi M L, Cremagnani L, Cantalamessa L
Istituto di Medicina Interna Malattie Infettive ed Immunopatologia Università degli Studi di Milano, IRCCS Ospedale Maggiore Policlinico, Pad. Granelli, Italy.
Ren Fail. 1995 Sep;17(5):629-37. doi: 10.3109/08860229509037629.
The activity of the hypothalamic-pituitary-adrenal axis in hemodialyzed (HD) patients has been investigated, with conflicting results. Different results are reported concerning both basal ACTH and cortisol concentration and the responses to different stimulating agents, in chronic hemodialyzed patients. The present study was performed in order to asses whether the length of the hemodialytic treatment may affect the pituitary and adrenocortical response to stimulation with ovine CRH (oCRH) and with exogenous ACTH in a group of patients on chronic HD for more than 10 years. Ten uremic patients (aged 38-71, 6 males and 4 females) on chronic hemodialysis for at least 10 years and 7 healthy subjects matched for age and sex were studied. The patients were tested on the day preceding dialysis session. Each subject received on different non-consecutive days oCRH (100 micrograms i.v. in bolus) and ACTH (Synacthen 0.25 mg i.v. in bolus), and blood samples were obtained at appropriate intervals. Basal ACTH and cortisol levels of HD patients were in the upper limit of normal range (ACTH 39.21 +/- 11.11 pg/mL in HD patients vs. 26.88 +/- 14.12 pg/mL in controls; cortisol 19.96 +/- 5.07 in HD patients vs. 12.66 +/- 4.44 in controls); however, the means were not significantly different compared with controls. Following oCRH administration a net increase of ACTH and cortisol was observed in every patient tested (ACTH peak 83.81 +/- 28.49 in HD vs. 78.73 +/- 22.87 pg/mL in controls; cortisol peak 30.73 +/- 19.31 in HD vs. 20.05 +/- 3.19 micrograms/dL in controls).(ABSTRACT TRUNCATED AT 250 WORDS)
对接受血液透析（HD）患者的下丘脑 - 垂体 - 肾上腺轴活性进行了研究，结果相互矛盾。关于慢性血液透析患者的基础促肾上腺皮质激素（ACTH）和皮质醇浓度以及对不同刺激剂的反应，有不同的报道。进行本研究是为了评估在一组接受慢性血液透析超过10年的患者中，血液透析治疗的时长是否会影响垂体和肾上腺皮质对羊促肾上腺皮质激素释放激素（oCRH）和外源性ACTH刺激的反应。研究了10名接受慢性血液透析至少10年的尿毒症患者（年龄38 - 71岁，6名男性和4名女性）以及7名年龄和性别匹配的健康受试者。患者在透析前一天接受测试。每位受试者在不同的非连续日期接受oCRH（静脉推注100微克）和ACTH（静脉推注0.25毫克赛诺同），并在适当的间隔时间采集血样。血液透析患者的基础ACTH和皮质醇水平处于正常范围的上限（血液透析患者的ACTH为39.21±11.11皮克/毫升，而对照组为26.88±14.12皮克/毫升；血液透析患者的皮质醇为19.96±5.07，而对照组为12.66±4.44）；然而，与对照组相比，平均值无显著差异。给予oCRH后，在每个受试患者中均观察到ACTH和皮质醇的净增加（血液透析患者的ACTH峰值为83.81±28.49，而对照组为78.73±22.87皮克/毫升；血液透析患者的皮质醇峰值为30.73±19.31，而对照组为20.05±3.19微克/分升）。（摘要截断于250字）
