危重症时早产儿促肾上腺皮质激素、皮质醇及醛固酮的变化

ACTH, cortisol and aldosterone level of preterm infants with critical illness

目的 以血清皮质醇、醛固酮、促肾上腺皮质激素（ACTH）水平作为监测指标,观察危重症对早产儿下丘脑-垂体-肾上腺（HPA）轴相关激素的影响.方法 以出生72 h内的早产儿90例（胎龄〈37周）为研究对象,分为胎龄≥34周组及胎龄〈34周组,在入院时及日龄7 d、14d行新生儿危重症评分,取最低值进行分组,分为危重组,非危重组;全部患儿分别在入院时及日龄7 d、14d时采血检测血清皮质醇、ACTH、醛固酮水平.结果 （1）危重组血清皮质醇浓度均高于非危重组.日龄≤72 h、胎龄≥34周早产儿危重组与非危重组比较,差异有显著性（t＝-2.263,P=0.029）;日龄14 d、胎龄〈34周早产儿危重组与非危重组比较,差异有显著性（t=-2.913,P=0.006）.（2）在危重组中,日龄≤72 h时,胎龄≥34周组血清皮质醇浓度显著高于胎龄〈34周组（t=-2.641,P=0.010）;日龄14 d时,胎龄〈34周组血清皮质醇浓度显著高于胎龄≥34周组（t=-2.189,P=0.036）.（3）胎龄≥34周危重组早产儿血清皮质醇浓度随日龄增加显著下降（F=4.679,P=0.012）.（4）ACTH、醛固酮水平危重组与非危重组比较,差异无显著性（P〉0.05）.结论 早产儿应激发生时机体已具有调节皮质醇分泌的能力,胎龄越大,这种能力越成熟.危重症时早产儿血清皮质醇浓度增高,血清醛固酮、ACTH浓度与疾病的严重程度无显著相关性.

Objective To investigate the effect of illness severity on preterm infant＇s hypothalamusputituary-adrenal （HPA） axis, we measured the serum concentration of cortisol,aldosterone and adrenocorticotropic hormone （ACTH）. Methods Ninety preterm infants who were transferred to our hospital within 72 hours after birth were involved. These preterm infants were divided into two groups：gestational age （GA） ≥34 weeks＇ preterm infants and GA 〈34 weeks＇ preterm infants. We evaluated these preterm infants at the time of admission,day 7 and day 14 after birth with neonatal critical illness score （NCIS）. Then they were divided into mild group and severe group by the lowest score. We measured their serum cortisol,aldosterone and ACTH at the time of admission,day 7 and day l4 after birth. Results （1） The serum cortisol concentration of preterm infants with severe illness was higher than that of preterm infants with mild illness. Among the GA ≥34 weeks＇ preterm infants,the serum cortisol concentration of preterm infants with severe illness was significandy higher than that of preterm infants with mild illness within 72 hours after birth （t = -2.263,P =0. 029）. Among the GA 〈34 weeks＇ preterm infants,the serum cortisol concentration of preterm infants with severe illness was significantly higher than that of preterm infants with mild illness on day 14 after birth （t =-2. 913 ,P =0. 006）. （2） Among the preterm infants with severe illness,the serum cortisol concentration of the GA≥34 weeks＇ was significantly higher than that of the GA 〈 34 weeks＇ within 72 hours after birth （t =-2. 641 ,P =0. 010） ;the serum cortisol concentration of the GA 〈34 weeks＇ was significantly higher than that of the GA≥34 weeks＇ on the day 14 after birth（t = -2. 189,P =0. 036） . （3） The serum cortisol concentration was significantly decreased in the GA≥34 weeks＇preterm infants （F = 4. 679, P =0. 012）. （4） The serum cortisol concentration of aldosterone and ACTH was not significantly different between preterm infants with severe illness and those with mild illness. Conclusion The preterm infant already has the ability to respond to stimuli by regulating cortisol secretion. The serum cortisol concentration increases as disease severity worsens.Serum aldosterone and ACTH concentration are not correlated with the severity of the disease.