危重肺部疾病早产儿肾上腺皮质功能不全及其与预后的关系

Study of adrenal insufficiency in preterm infants with critical lung diseases and its relationship with prognosis

目的探讨危重肺部疾病早产儿肾上腺皮质功能不全的发生及其与预后的关系。方法对纳入的50例危重肺部疾病早产儿采用化学发光法测定基础皮质醇及ACTH浓度,同时行小剂量ACTH(1μg/kg)刺激实验,30 min后测其峰值,若基础皮质醇<15μg/dl或皮质醇增值<9μg/dl定义为肾上腺皮质功能不全。肾上腺皮质功能不全早产儿为AI组,其余早产儿归为肾上腺皮质功能正常(AN组)。结果 50例危重肺部疾病早产儿中,31例肾上腺皮质功能不全,发生率62.0%。AI组血清基础皮质醇以及ACTH刺激试验后皮质醇峰值均低于AN组,差异有统计学意义(P<0.01);但两组皮质醇增值的差异无统计学意义(P>0.05);AI组ACTH浓度低于AN组,差异有统计学意义(P<0.01)。AI组平均动脉压也低于AN组,差异有统计学意义(P<0.01)。AI组与AN组早产儿的血糖、血钾、血钠水平差异均无统计学意义(P>0.05);两组死亡率及支气管肺发育不良(BPD)发生率的差异也均无统计学意义(P>0.05)。结论危重肺部疾病早产儿肾上腺皮质功能不全发生率高,其发生可能继发于内源性ACTH产生相对不足;危重肺部疾病早产儿肾上腺皮质功能不全时血压偏低,但未发现其死亡及BPD发生与肾上腺皮质功能不全有关。

Objective To explore adrenal insufficiency in the preterm infants who had critical lung diseases and the relationship between adrenal insufficiency and long-term or short-term prognosis.Methods The basal cortisol and ACTH of fifty preterm infants enrolled were tested.The peak cortisol at 30 minutes after low dose ACTH stimulation was tested.The adrenal insufficiency was defined as the concentration of the basal cortisol less than 15 μg/dl or the increment of cortisol concentration after low dose ACTH stimulation less than 9 μg/dl.The pretern infants with adrenal insufficiency were the AI group and others were the adrenal normality,AN group.Results Thirty-one cases were adrenal insufficiency in 50 preterm infants with critical lung disease.The incidence was 62%.The concentrations of the basal and peak cortisol in AI group were lower than those in AN group（P〈0.01）.The increment of cortisol concentration after low dose ACTH stimulation had not significant difference between two groups.The concentration of ACTH in AI group was lower than that in AN group（P〈0.01）.The mean arterial blood pressure in AI group was lower than that in AN group（P〈0.01）.The blood sugar,potassium and sodium had no significant difference between two groups（P〉0.05）.There was no significant difference in the mortality and the incidence of BPD between two groups（P〉0.05）.Conclusions The incidence of adrenal insufficiency was high in the preterm infants with critical lung diseases,which may be due to insufficient production of endogenous ACTH.When the adrenal insufficiency was happened,the blood pressure is relatively low in preterm infants with critical lung diseases,but it was not related to the mortality and the incidence of BPD.