小剂量促肾上腺皮质激素刺激实验在儿童危重症相关性肾上腺皮质功能障碍评估中的意义

摘要

Objective To study the significance of stimulation with small dosage of adrenocorticotropic hormone in children with critical illness - related corticosteroid insufficiency(CIRCI). Methods A total of 102 pediatric patients with CIRCI in ICU of this hospital during Febru-ary 2012 to February 2014 were allocated in this study. ACTH stimulating test had been applied in all these patients,54 cases of them were listed in CIRCI group;the remaining cases were set in control group,and the laboratory indexes and basic levels of cortisol(T0),levels of cortisol after stimulation(T1),the adrenal function under different purpose of study,different critical scores and adrenal function in patients with different age range had been examined and compared. Results There was no significant difference between these two groups of children with laboratory indexes and T0( P ﹥ 0. 05). The level of T1 in CIRCI group was significantly lower than that of control group,and the difference was statistically signifi-cant( P ﹤ 0. 05). In patients with infection,PRISM Ⅲ scores and the level of organ dysfunction were compared between these 2 groups,and the difference in T0,T1,and incidence of CIRCI had no statistical significance( P ﹥ 0. 05). The levels of T0 and T1 in critically ill patients with scores of 70 ~ 90 were significantly lower than those with 70 points or less,and the difference was statistically significant( P ﹤ 0. 05). But the difference in CIRCI had no statistical significance( P ﹥ 0. 05). In term of age,as the growth of age of children,levels of T0 and T1 were de-creased,and the difference between these 2 groups was statistically significant( P ﹤ 0. 05). But difference in incidence of CIRCI between all groups was not statistically significant( P ﹥ 0. 05). Conclusion The application of small dosage of ACTH stimulating test in evaluation of chil-dren with CIRCI has certain significance in prediction of patients with severe form of disease,but it is advised that it should be applied with other kinds of determination methods. Thus more reliable prediction of the progression of disease can be made.%目的：研究小剂量促肾上腺皮质激素（ACTH）刺激实验在儿童危重症相关性肾上腺皮质功能障碍（CIR-CI）评估中的意义。方法选择2012年2月至2014年2月儿童 ICU 病房接受治疗的102例患儿作为研究对象。对所有患儿进行 ACTH 刺激试验，54例 CIRCI 患儿设为 CIRCI 组；其余设为正常组。对比观察两组实验室检查指标和基础性皮质醇的浓度（T0）、刺激后的皮质醇浓度（T1），不同研究方向下的肾上腺功能情况，以及不同危重评分及年龄段患者的肾上腺功能情况。结果两组患儿实验室检查指标及 T0无显著差异（ P ﹥0.05）。CIRCI 组的 T1水平均显著低于正常组，差异有统计学意义（ P ﹤0.05）。患儿在感染情况、PRISM Ⅲ评分及器官障碍数目等研究方向上分别进行组间对比，T0、T1及 CIRCI 发生率的差异均无统计学意义（均 P ﹥0.05）。危重评分值为70~90分的患儿 T0及 T1水平显著低于≤70分者的水平，差异有统计学意义（ P ﹤0.05）。但对比 CIRCI 发生率的差异无统计学意义（ P ﹥0.05）。在年龄阶段方面，随着儿童年龄的增长，T0及 T1的水平均下降，各组间差异有统计学意义（ P ﹤0.05）。但对比各组间 CIR-CI 发生率，差异均无统计学意义（均 P ﹥0.05）。结论小剂量的 ACTH 刺激试验对 CIRCI 患儿进行评估，对其疾病危重形式有一定的预测价值，但提倡与其他种类的测定方式联合应用，从而更加可靠地预测疾病进展。