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目的以血清皮质醇水平作为监测指标,观察其变化与临床的相关性,评价危重症早产儿皮质醇水平与短期预后之间的关系。方法出生72h内转入湖南省儿童医院新生儿科的早产儿90例(胎龄<37周),排除遗传代谢性疾病,母孕期及患儿出生时均未用过糖皮质激素。全部患儿分别在入院时(日龄72h内)、日龄7d、日龄14d静脉采血,留取血标本,分离血清,放射免疫法检测血清皮质醇水平。3个时间点皮质醇水平进行比较。结果血清皮质醇水平在下四分位组(P25之下)时,发病率及病死率无明显增高。血清皮质醇水平在上四分位组(P75之上)时,机械通气、危重患儿比例、病死率、糖代谢紊乱、消化道出血、Ⅲ～Ⅳ级脑室周围-脑室内出血及脑白质软化、慢性肺疾病发病率呈上升趋势。其中在入院时及日龄14d时,血清皮质醇水平在上四分位组的患儿,机械通气的比例显著增高,差异有统计学意义(P<0.05);日龄7d时及日龄14d时,危重症患儿比例显著增高,差异有统计学意义(P<0.05)。结论在早产儿中,应激发生时机体已具有调节皮质醇分泌的能力。血清皮质醇水平增高与疾病的严重程度、并发症及预后密切相关。
Objective To evaluate the relationship between cortisol level and short-term prognosis in critically ill preterm infants by monitoring serum cortisol level as a monitoring indicator and observing the relationship between changes and clinical changes. Methods Totally 90 preterm infants (gestational age <37 weeks) who were transferred to neonatology department of Children’s Hospital of Hunan Province within 72 hours of birth were excluded from genetic metabolic diseases. All the patients were born without corticosteroids during the first trimester of pregnancy and at birth. All children were admitted to hospital (day 72h), day 7d, day 14d vein blood, blood samples were taken, serum was separated, serum cortisol levels were measured by radioimmunoassay. Cortisol levels were compared at 3 time points. Results Serum cortisol levels in the lower quartile (P25 below), the incidence and mortality was no significant increase. Serum cortisol levels in the upper quartile (P75 above), mechanical ventilation, the proportion of critically ill children, case fatality, glucose metabolism disorders, gastrointestinal bleeding, grade Ⅲ ~ Ⅳ periventricular - intraventricular hemorrhage and white matter softening, The incidence of chronic lung disease is on the rise. At admission and at 14 days of age, the proportion of patients with serum cortisol in the upper quartile was significantly higher (P <0.05); on day 7 and day 14 , The proportion of critically ill children was significantly increased, the difference was statistically significant (P <0.05). Conclusion In preterm infants, the body has the ability to regulate cortisol secretion during stress. Serum cortisol levels increased with the severity of the disease, complications and prognosis are closely related.