重症儿童肾上腺皮质功能不全及肾上腺危象研究进展

Progress in the adrenal insufficient and adrenal crisis of critical children

研究发现肾上腺皮质功能不全在重症儿童的某些疾病（如全身炎症反应综合征、脓毒血症、休克等）中普遍存在，肾上腺危象的发生率也比预期高。目前糖皮质激素替代治疗倾向于小剂量氢化可的松20—25mg／（m2·d）口服。实验室检查用游离皮质醇指数和计算游离皮质醇来评估肾上腺皮质功能，并采用新的温度控制离心超滤法结合化学发光免疫分析检测游离皮质醇，增加了该检测的临床实用性。

Recent studies have showed that adrenal insufficiency are common in some status of critically ill children,like systemic inflammatory response syndrome, sepsis, shock, et al. The frequency of adrenal crisis was also higher than expectation. The currrent glucocorticoid replacement therapies are inclined to lower dose I hydrocortisone 20 ~ 25 mg/（ m2. d） ]. The adrenal function could be evaluated with the free cortisol index and calculated free cortisol. A new method, temperature-controlled centrifugal ultrafiltration with chemiluminescence immunoassay, has been used to detect the free cotisol, which has improved the clinical practicality.