CAJ | 학술논문

目的：研究小剂量促肾上腺皮质激素（ACTH）刺激实验在儿童危重症相关性肾上腺皮质功能障碍（CIR-CI）评估中的意义。方法选择2012年2月至2014年2月儿童 ICU 病房接受治疗的102例患儿作为研究对象。对所有患儿进行 ACTH 刺激试验，54例 CIRCI 患儿设为 CIRCI 组；其余设为正常组。对比观察两组实验室检查指标和基础性皮质醇的浓度（T0）、刺激后的皮质醇浓度（T1），不同研究方向下的肾上腺功能情况，以及不同危重评分及年龄段患者的肾上腺功能情况。结果两组患儿实验室检查指标及 T0无显著差异（ P ﹥0.05）。CIRCI 组的 T1水平均显著低于正常组，差异有统计学意义（ P ﹤0.05）。患儿在感染情况、PRISM Ⅲ评分及器官障碍数目等研究方向上分别进行组间对比，T0、T1及 CIRCI 发生率的差异均无统计学意义（均 P ﹥0.05）。危重评分值为70~90分的患儿 T0及 T1水平显著低于≤70分者的水平，差异有统计学意义（ P ﹤0.05）。但对比 CIRCI 发生率的差异无统计学意义（ P ﹥0.05）。在年龄阶段方面，随着儿童年龄的增长，T0及 T1的水平均下降，各组间差异有统计学意义（ P ﹤0.05）。但对比各组间 CIR-CI 发生率，差异均无统计学意义（均 P ﹥0.05）。结论小剂量的 ACTH 刺激试验对 CIRCI 患儿进行评估，对其疾病危重形式有一定的预测价值，但提倡与其他种类的测定方式联合应用，从而更加可靠地预测疾病进展。
목적：연구소제량촉신상선피질격소（ACTH）자격실험재인동위중증상관성신상선피질공능장애（CIR-CI）평고중적의의。방법선택2012년2월지2014년2월인동 ICU 병방접수치료적102례환인작위연구대상。대소유환인진행 ACTH 자격시험，54례 CIRCI 환인설위 CIRCI 조；기여설위정상조。대비관찰량조실험실검사지표화기출성피질순적농도（T0）、자격후적피질순농도（T1），불동연구방향하적신상선공능정황，이급불동위중평분급년령단환자적신상선공능정황。결과량조환인실험실검사지표급 T0무현저차이（ P ﹥0.05）。CIRCI 조적 T1수평균현저저우정상조，차이유통계학의의（ P ﹤0.05）。환인재감염정황、PRISM Ⅲ평분급기관장애수목등연구방향상분별진행조간대비，T0、T1급 CIRCI 발생솔적차이균무통계학의의（균 P ﹥0.05）。위중평분치위70~90분적환인 T0급 T1수평현저저우≤70분자적수평，차이유통계학의의（ P ﹤0.05）。단대비 CIRCI 발생솔적차이무통계학의의（ P ﹥0.05）。재년령계단방면，수착인동년령적증장，T0급 T1적수평균하강，각조간차이유통계학의의（ P ﹤0.05）。단대비각조간 CIR-CI 발생솔，차이균무통계학의의（균 P ﹥0.05）。결론소제량적 ACTH 자격시험대 CIRCI 환인진행평고，대기질병위중형식유일정적예측개치，단제창여기타충류적측정방식연합응용，종이경가가고지예측질병진전。
Objective To study the significance of stimulation with small dosage of adrenocorticotropic hormone in children with critical illness - related corticosteroid insufficiency(CIRCI). Methods A total of 102 pediatric patients with CIRCI in ICU of this hospital during Febru-ary 2012 to February 2014 were allocated in this study. ACTH stimulating test had been applied in all these patients,54 cases of them were listed in CIRCI group;the remaining cases were set in control group,and the laboratory indexes and basic levels of cortisol(T0),levels of cortisol after stimulation(T1),the adrenal function under different purpose of study,different critical scores and adrenal function in patients with different age range had been examined and compared. Results There was no significant difference between these two groups of children with laboratory indexes and T0( P ﹥ 0. 05). The level of T1 in CIRCI group was significantly lower than that of control group,and the difference was statistically signifi-cant( P ﹤ 0. 05). In patients with infection,PRISM Ⅲ scores and the level of organ dysfunction were compared between these 2 groups,and the difference in T0,T1,and incidence of CIRCI had no statistical significance( P ﹥ 0. 05). The levels of T0 and T1 in critically ill patients with scores of 70 ~ 90 were significantly lower than those with 70 points or less,and the difference was statistically significant( P ﹤ 0. 05). But the difference in CIRCI had no statistical significance( P ﹥ 0. 05). In term of age,as the growth of age of children,levels of T0 and T1 were de-creased,and the difference between these 2 groups was statistically significant( P ﹤ 0. 05). But difference in incidence of CIRCI between all groups was not statistically significant( P ﹥ 0. 05). Conclusion The application of small dosage of ACTH stimulating test in evaluation of chil-dren with CIRCI has certain significance in prediction of patients with severe form of disease,but it is advised that it should be applied with other kinds of determination methods. Thus more reliable prediction of the progression of disease can be made.