小剂量快速法ACTH(1～39)兴奋试验评价肾病综合征患儿肾上腺皮质功能初探

Preliminary study on evaluating adrenal function in nephrotic syndrome patients by low-dose rapid ACTH_(1-39) stimulation tes

目的尝试以国产ACTH1~39小剂量快速法ACTH兴奋试验评价肾病综合征患儿肾上腺皮质功能。方法以18例泼尼松治疗不同阶段的肾病综合征患儿为研究对象,同一患儿于泼尼松治疗第1和第3天先后进行小剂量快速法ACTH兴奋试验（静脉注射ACTH1-391U,）和2h法兴奋试验（ACTH1-3925U溶于100mL葡萄糖溶液中静脉滴注2h）,两次试验结果进行自身对照分析。结果首次泼尼松治疗前、泼尼松足量分次服用和减量但仍每日均服用的10例患儿两种试验方法自身对照的结果完全一致,隔日顿服泼尼松的8例患儿中也有5例结果完全一致,仅3例泼尼松隔日顿服,用量在1mg·kg^-1患儿两种试验方法的结果不一致,小剂量快速法的结果为肾上腺皮质功能低下,而2h法的结果为肾上腺功能正常。对两种试验结果进行Kappa分析显示两者一致性好。结论ACTH1-39可以代替ACTH1-24进行小剂量快速法ACTH兴奋试验;小剂量快速法与2h法ACTH1-39兴奋试验的结果一致性好,且简单易行,能够在门诊完成,可以考虑用来替代2h法ACTH1-39评价肾病综合征患儿的肾上腺皮质功能。

Objective Recently, a lot of papers have been published in abroad which recommended low-dose rapid ACTH1-24 stimulation test instead of large-dose ACTH1-24 stimulation test when evaluating adrenocortical insufficiency. There was no similar research report in China. This study used ACTH1 -39to replace ACTH1-24 for performing low-dose rapid ACTH stimulation test. A self control design was also used to compare the results of low-dose rapid ACTH stimulation test with conventional 2-hour ACTH stimulation test. Methods Two kinds of ACTH stimulation tests were performed in 18 patients with nephritic syndrome on alternate days. On day 1, low-dose rapid ACTH stimulation test was performed. 1 U ACTH was injected as an intravenous bolus after collection of a sample at 0 min. Another sample was drawn at 25 min for cortisol measurement. On day 3, conventional 2-hour ACTH stimulation test was performed. 25 U ACTH was injected as an intravenous drip for 2 hours after collection of a sample at 0 min. The other sample was attained at 2 hour for cortisol measurement. ACTH1-24 was replaced by ACTH1-39 in both low-dose rapid ACTH stimulation test and conventional 2-hour ACTH stimulation test. Student＇s test and Kappa analysis were used for statistical analysis. Results The results of two kinds of tests were completely equal in 10 cases who took prednisone daily or prior treatment. 8 cases took prednisone every other day, 5 cases of them showed the same results in the two tests. Only 3 cases showed different results in the two tests, who took prednisone more than 1 mg ~ kg-I every other day. The low-dose rapid ACTH stimulation test revealed a diminished adrenocortical reserve, while the traditional 2-hour ACTH stimulation test was normal. Kappa analysis of paired results showed good concordance. Conclusions ACTH,-39 could substitute ACTH, _24 to perform low-dose rapid ACTH stimulation test. The two kinds of ACTH stimulation tests had good correlation. Compared with the traditional 2-hour ACTH stimulation test ,the low-dose rapid ACTH stimulation test was more convenient and could be performed in out-patient clinic. So the low-dose rapid ACTH stimulation test may replace the conventional 2-hour ACTH stimulation test for evaluating adrenocortical function.