Legakis I, Saramantis A, Voros D, Chalevelakis G, Tolis G
Department of Endocrinology, Hippokrateion General Hospital, Athens, Greece.
Horm Metab Res. 1998 Sep;30(9):570-4. doi: 10.1055/s-2007-978935.
The function of the hypothalamic-pituitary-adrenal axis as related to the degree of severity of a septic process was assessed by measuring plasma levels of beta-endorphin, ACTH and cortisol. Sixty-one cases of postoperative patients treated at the intensive care unit were classified into four groups according to the severity of infection: Group 1 (control) included patients who did not show any sign of infection, group 2 patients with sepsis, group 3 patients with septic syndrome and group 4 patients with septic shock. Compared to G1 patients' ACTH values (4.16+/-2.6pg/ml), a statistically significant increase in ACTH values in various stages of septicemia (p < 0.005) with a noticeable difference also between G3 (7.11 +/-3.7pg/ml) and G4 (11.5+/-6.6pg/ml) (p<0.05) was found. Differences were also observed in beta-endorphin (with a level of significance between the several groups of p = 0.0001). Also, beta-endorphin values in G4 (40.6+/-30.3 pg/ml) differed significantly from each of G1 (17.5 +/-6.6 pg/ml), G2 (21.1+/-11.3 pg/ml) and G3 (23.5+/-12 pg/ ml) (p<0.05). A progressive hypercortisolemia was obvious, with values of G4 (37.2+/-15.6 microg/dl) differing significantly from those of G1 (18+/-4.6microg/dl) and G2 (24-/+8.4microg/dl) (p<0.05) and of G3 (28.5+/-12.3 microg/dl) from that of G1 (p < 0.05). Interestingly, a dissociation of ACTH, beta-endorphin and cortisol was observed, in that the increased values of beta-endorphin and cortisol, detected in the G3 were not associated with a parallel increase in ACTH. These findings might be interpreted in the sense of an impairment of the stress stimulation of the hypothalamic pituitary adrenal axis. Provided that such a situation can be lethal, our results further confirm the idea that a low-dose, steroid replacement might be beneficial to critical illness.
通过测量血浆中β-内啡肽、促肾上腺皮质激素（ACTH）和皮质醇的水平，评估了下丘脑-垂体-肾上腺轴功能与脓毒症进程严重程度之间的关系。对在重症监护病房接受治疗的61例术后患者，根据感染严重程度分为四组：第1组（对照组）包括未表现出任何感染迹象的患者，第2组为脓毒症患者，第3组为脓毒综合征患者，第4组为脓毒性休克患者。与第1组患者的ACTH值（4.16±2.6pg/ml）相比，败血症各阶段的ACTH值有统计学显著升高（p<0.005），且第3组（7.11±3.7pg/ml）和第4组（11.5±6.6pg/ml）之间也有明显差异（p<0.05）。β-内啡肽也存在差异（几组之间的显著性水平为p = 0.0001）。此外，第4组的β-内啡肽值（40.6±30.3 pg/ml）与第1组（17.5±6.6 pg/ml）、第2组（21.1±11.3 pg/ml）和第3组（23.5±12 pg/ml）中的每一组均有显著差异（p<0.05）。明显存在进行性高皮质醇血症，第4组的值（37.2±15.6μg/dl）与第1组（18±4.6μg/dl）和第2组（24±8.4μg/dl）有显著差异（p<0.05），第3组（28.5±12.3μg/dl）与第1组有显著差异（p<0.05）。有趣的是，观察到ACTH、β-内啡肽和皮质醇之间的解离，即第3组中检测到的β-内啡肽和皮质醇值升高与ACTH的平行升高无关。这些发现可能意味着下丘脑-垂体-肾上腺轴的应激刺激受损。鉴于这种情况可能是致命的，我们的结果进一步证实了低剂量类固醇替代疗法可能对危重病有益的观点。
