【作者】 刘霞；

【导师】 黄绮薇；

【作者基本信息】 上海交通大学 ， 新生儿， 2007， 硕士

【摘要】 目的:本研究旨在明确脓毒症新生儿肾上腺皮质的功能状态,肾上腺皮质功能不全的发生率,肾上腺皮质功能与脓毒症病情及预后的关系。方法:本研究对象为入住我院新生儿科≥36周的新生儿80例,其中对照组新生儿20例,实验组脓毒症新生儿60例,实验组又进一步分为脓毒症组49例和严重脓毒症组11例。本研究检测血清基础皮质醇水平及小剂量ACTH激发试验后的峰值皮质醇水平,血清皮质醇水平采用化学发光免疫技术检测。结果:1、对照组血清基础皮质醇平均水平为10.62ug/dl(95%可信区间7.91~13.34ug/dl),小剂量ACTH激发试验后血清皮质醇峰值平均水平为31.51ug/dl(95%可信区间27.88~35.14ug/dl);实验组血清基础皮质醇平均水平为31.64ug/dl ( 95%可信区间25.29~36.93ug/dl),小剂量ACTH激发试验后血清皮质醇峰值平均水平为47.63ug/dl(95%可信区间42.56~52.71ug/dl);实验组血清基础皮质醇平均水平明显高于对照组,P=0.0001<0.01,有统计学意义,实验组血清皮质醇峰值平均水平亦明显高于对照组,P=0.0001<0.01,有统计学意义。2、脓毒症组血清基础皮质醇平均水平为23.24ug/dl(95%可信区间18.22~28.27ug/dl),小剂量ACTH激发试验后血清皮质醇峰值平均水平为42.04ug/d(l95%可信区间37.36~46.73ug/dl);严重脓毒症组血清基础皮质醇平均水平为51.89ug/dl(95%可信区间33.26~70.51ug/dl),小剂量ACTH激发试验后血清皮质醇峰值平均水平为60.36ug/dl(95%可信区间45.60~75.12ug/dl);严重脓毒症组血清基础皮质醇平均水平明显高于脓毒症组,P=0.0021<0.01,有统计学意义,严重脓毒症组血清皮质醇峰值平均水平亦明显高于脓毒症组,P=0.0026<0.01,有统计学意义。3、本研究采用的脓毒症新生儿肾上腺皮质功能不全的诊断标准为:血清基础皮质醇水平<15ug/dl,或小剂量ACTH激发试验后血清皮质醇峰值水平<17ug/dl。本研究60例脓毒症新生儿中肾上腺皮质功能不全的有18例,其血清基础皮质醇平均水平为7.69ug/dl(95%可信区间5.62~9.76ug/dl),小剂量ACTH激发试验后血清皮质醇峰值平均水平为31.43ug/dl(95%可信区间26.35~36.51ug/dl);肾上腺皮质功能正常的脓毒症新生儿血清基础皮质醇平均水平为35.27ug/d(l95%可信区间29.29~41.26ug/dl),小剂量ACTH激发试验后血清皮质醇峰值平均水平为50.16ug/dl(95%可信区间44.53~55.79ug/dl);肾上腺皮质功能正常的脓毒症新生儿血清基础皮质醇平均水平明显高于肾上腺皮质功能不全者,P=0.0001<0.01,有统计学意义,肾上腺皮质功能正常的脓毒症新生儿血清皮质醇峰值平均水平亦明显高于肾上腺皮质功能不全者,P=0.0001<0.01,有统计学意义。4、本研究中脓毒症组新生儿无死亡病例,严重脓毒症组新生儿死亡6例, P=0.0000<0.01,两组的病死率有统计学差异;肾上腺皮质功能不全的脓毒症新生儿死亡1例,肾上腺皮质功能正常的脓毒症新生儿死亡5例,P=0.658>0.05,两组的病死率无统计学差异。结论:脓毒症新生儿在应激状态下血清皮质醇的合成分泌增加,且病情越重,血清基础皮质醇的水平越高;脓毒症新生儿血清基础皮质醇水平越高,死亡风险增加,脓毒症新生儿的病死率与病情的严重程度呈正相关。大部分脓毒症新生儿对应激的应答水平是足够的,也有一部分脓毒症新生儿可继发肾上腺皮质功能不全,本研究尚未发现脓毒症新生儿病死率与肾上腺皮质功能不全之间存在相关性。更多还原

【Abstract】 Objective To observe the adrenal function in neonates with sepsis, the incidence of adrenal insufficiency in neonates with sepsis, and explore the relationships between adrenal function and severity of sepsis.Method 80 neonates (gestational age≥36w) were selected from shanghai children hospital, these neonates were divided into 2 group consisting of 20 neonates ( as control group) and 60 neonates with sepsis (as experimental group) respectively. 60 neonates with sepsis were subdivided into 2 group according to whether they are severe sepsis , severe sepsis (SS) group consisted of 11 neonates and sepsis (S) group consisted of 49 neonates. The venous blood samples were collected and 30 minutes after low-dose ACTH stimulation test respectively. The serum cortisol levels were measured by chemiluminescence immunoassay.Results 1. Control group: the mean basal serum cortisol level was 10.62ug/dl (95%CI 7.91~13.34ug/dl), the mean peak serum cortisiol level after low-dose ACTH test was 31.51ug/dl (95%CI 27.88~35.14ug/dl); experimental group: the mean basal serum cortisol level was 31.64ug/dl (95%CI 25.29~36.93ug/dl), the mean peak serum cortisiol level after low-dose ACTH test was 47.63ug/dl (95%CI 42.56~52.71ug/dl); The mean basal serum cortisol level of experimental group was significantly higher than that of the control group (P=0.0001<0.01), The mean peak serum cortisol level of the experimental group was significantly higher than that of the control group (P=0.0001<0.01). 2. S group: the mean basal serum cortisol level was 23.24ug/dl (95%CI 18.22~28.27ug/dl), the mean peak serum cortisiol level after low-dose ACTH test was 42.04ug/dl (95%CI 37.36~46.73ug/dl); SS group: the mean basal serum cortisol level was 51.89ug/dl (95%CI 33.26~70.51ug/dl), the mean peak serum cortisiol level after low-dose ACTH test was 60.36ug/dl (95%CI 45.60~75.12ug/dl); The mean basal serum cortisol level of SS group was significantly higher than that of the S group (P=0.0021<0.01), The mean peak serum cortisol level of the SS group was significantly higher than that of the S group (P=0.0026<0.01). 3. Basal serum cortisol level<15ug/dl, or peak serum cortisol level after low-dose ACTH test <17ug/dl were used to define adrenal insufficiency, and was observed in 18 of the 60 neonates with sepsis. The mean basal serum cortisol level of the neonates with adrenal insufficiency was 7.69ug/dl (95%CI 5.62~9.76ug/dl), their mean peak serum cortisol level after low-dose ACTH test was 31.43ug/dl (95%CI 26.35~36.51ug/dl); The mean basal serum cortisol level of the neonates with adequate adrenal response was 35.27ug/dl (95%CI 29.29~41.26ug/dl), their mean peak serum cortisol level after low-dose ACTH test was 50.16ug/dl (95%CI 44.53~55.79 ug/dl); The mean basal serum cortisol level of the neonates with adequate adrenal response was significantly higher than that of the neonates with adrenal insufficiency (P=0.0001<0.01), the mean peak serum cortisol level of the neonates with adequate adrenal response was significantly higher than that of the neonates with adrenal insufficiency (P=0.0001<0.01). 4. None neonate died in the S group, 6 neonates died in the SS group. The mortality of the SS group was significantly higher than that of the S group (P=0.0000<0.01); 1 neonate with adrenal insufficiency and 5 neonates with adequate adrenal response died, there was no significant difference in their mortality (P=0.658>0.05).Conclusion The basal serum cortisol was significantly increased in stressed neonates with sepsis and it was positively correlated with the severity and the mortality of sepsis. The response of adrenal to stress was adequate in most neonates with sepsis, A few neonates with sepsis developed adrenal insufficiency. We found no relationship between the mortality and adrenal insufficiency.更多还原