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目的:探讨危重新生儿肾上腺皮质功能状态与病情严重程度的关系及促肾上腺皮质激素(ACTH)刺激试验对肾上腺皮质功能不全患儿预后的作用。方法:根据新生儿危重病例评分法(NCIS),将2011年10月~2012年11月石河子大学医学院第一附属医院收治的34周≤胎龄﹤42周、日龄<2天的60例新生儿分为非危重组、轻度危重组和重度危重组,采用化学发光免疫技术检测患儿皮质醇水平;根据皮质醇水平将危重患儿分为肾上腺皮质功能不全(AI)组和肾上腺皮质功能正常(AN)组;对危重患儿中合并AI者进行小剂量ACTH刺激试验,观察皮质醇水平及血压、血糖、血钾和血钠水平的变化。结果:非危重组、轻度危重组和重度危重组皮质醇水平分别为(12.82±3.96)μg/dL、(20.72±10.65)μg/dL和(21.67±8.58)μg/dL,轻度危重组和重度危重组皮质醇水平高于非危重组(P<0.05);轻度危重组与重度危重组皮质醇水平比较差异无统计学意义(P>0.05);轻度危重组和重度危重组AI的发生率分别为28.57%和47.37%,二者比较差异有统计学意义(P<0.05);危重患儿中,AI组的皮质醇水平、收缩压和血糖水平低于AN组(P<0.05),血钾和血钠水平比较差异无统计学意义(P>0.05);合并AI的患儿中,小剂量ACTH刺激试验后的皮质醇水平、收缩压和血糖水平较刺激试验前升高,血钾和血钠水平比较差异无统计学意义(P>0.05)。结论:危重新生儿肾上腺皮质功能状态与病情严重程度有关,皮质醇水平在轻度危重症时升高,当病情进一步加重时却未相应升高;危重新生儿合并AI时血压及血糖水平偏低;ACTH刺激能有效升高皮质醇、收缩压及血糖水平,具有一定的治疗作用。
Objective: To investigate the relationship between functional status of adrenal cortex and severity of critically ill newborn infants and the effect of adrenocorticotrophic hormone (ACTH) stimulation test on the prognosis of children with adrenal insufficiency. Methods: According to the Neonatal Critical Illness Scale (NCIS), 60 patients with gestational age <42 weeks and days <2 days 34 weeks after birth in the First Affiliated Hospital of Shihezi University from October 2011 to November 2012 were enrolled. Neonates were divided into non-critical group, mild-severe group and severe-severe group. The level of cortisol in children was detected by chemiluminescence immunoassay. According to the level of cortisol, the critically ill children were divided into adrenal insufficiency (AI) group and adrenal cortex (AN) group. In low-dose ACTH stimulation group, the patients with complicated AI in critically ill children were observed. The changes of cortisol and blood pressure, blood glucose, serum potassium and serum sodium were observed. Results: The levels of cortisol were (12.82 ± 3.96) μg / dL, (20.72 ± 10.65) μg / dL and (21.67 ± 8.58) μg / dL respectively in the non-critically ill group, mild- (P <0.05). There was no significant difference in the level of cortisol between mild and severe critically ill patients (P> 0.05). The levels of Cortisol in mild and severe critically ill patients were significantly higher than those in non-critically ill patients (P <0.05) (P <0.05). The incidence of cortisol, systolic blood pressure and blood glucose in AI group were significantly lower than those in AN group (P <0.05) ), Serum potassium and serum sodium levels were not significantly different (P> 0.05); cortisol levels, systolic blood pressure and blood glucose levels in low-dose ACTH stimulation test in children with AI were higher than those before stimulation test, Serum potassium and serum sodium levels were no significant difference (P> 0.05). Conclusions: The functional status of adrenocortical in critically ill neonates is related to the severity of the disease. Cortisol level is elevated in mild critically ill patients but not increased when the condition is further aggravated. Blood pressure and blood glucose levels are low in critically ill newborns with AI ; ACTH stimulation can effectively increase cortisol, systolic blood pressure and blood glucose levels, has a certain therapeutic effect.