性激素对腹部外科疾病伴全身炎症反应综合征患者预后的影响

目的 评价血清性激素水平在腹部外科疾病伴全身炎症反应综合征(SIRS)患者病情预后评估中的应用价值.方法采用前瞻性、单中心、观察研究方法.选择2009年7月10日至2010年2月9日天津市南开医院外科重症监护病房(SICU)收治的39例腹部外科疾病伴SIRS患者,根据患者入院72 h内的血清雌二醇、泌乳素及睾酮水平(用放射免疫法检测)分为雌二醇升高组(20例)和未升高组(19例)、泌乳素升高组(16例)和未升高组(23例)、睾酮降低组(14例)和未降低组(25例),分别观察各组患者急性生理学与慢性健康状况评分系统Ⅱ (APACHE Ⅰ)评分、总住院时间、住ICU时间、总住院费用及28 d转归.结果 与雌二醇未升高组比较,雌二醇升高组APACHEⅡ评分(分)有所降低,但差异无统计学意义(11.6±7.8比15.2±8.8,P＞0.05),住ICU时间(d)明显缩短(8.5±4.0比12.1±7.9,P＜0.05),28d病死率明显降低(10.0％比35.7％,P＜0.05).与泌乳素未升高组比较,泌乳素升高组住ICU时间(d)明显缩短(8.7±3.1比12.9±2.1,P＜0.01),总住院费用(万元)明显降低(6.70±3.50比13.20±8.20,P＜0.05).与睾酮未降低组比较,睾酮降低组APACHEⅡ评分(分)明显降低(10.4±5.4比15.2±9.4,P＜0.05),住ICU时间(d)明显缩短(26.6±12.2比28.1±17.0,P＜0.01),28 d病死率明显降低(0比31.8％,P＜0.01).结论 腹部外科疾病伴SIRS患者早期血清雌激素、泌乳素及睾酮水平对患者的预后有显著影响.

The effect of changes in the level of sex hormone on prognosis of abdominal surgical systemic inflammatory response syndrome

Objective To examine if the serum level of 3 sex hormones early after admission are correlated with the prognosis in post-abdominal surgery patients with systemic inflammatory response syndrome (SIRS).Methods 39 patients admitted to our surgical intensive care unit (SICU) for abdominal surgery were divided,according to their serum level of estradiol (E2),prolactin (PRL),and testosterone (TT),into:(① E2 elevation group (n=20),② E2 normal group (n =19),③ PRL elevation group (n=16),④PRL normal group (n=23),⑤ TT reduction group (n=14),and ⑥ TT normal group (n=25),for data collection of:acute physiology and chronic health evaluation Ⅱ (APACHE Ⅰ ) scores,total hospitalization days,ICU stay,total hospitalization cost and 28 day outcomes.Results In comparison with corresponding normal group,E2 elevation group had lower (but not statistically significant) APACHE Ⅱ score ( 11.6 ± 7.8 vs.15.2 ± 8.8,P＞ 0.05),significantly shorter ICU stay (days:8.5 ± 4.0 vs.12.1± 7.9,P＜0.05),and significantly lower 28 days mortality rate (10.0％ vs.35.7％,P＜0.05); PRL elevation group had significantly shorter ICU stay (days:8.7± 3.1 vs.12.9± 2,1,P＜0.01),and significantly lower total hospitalization cost (thousand yuan:6.70±3.50 vs.13.20±8.20,P＜0.05); TT reduction group had significantly lower APACHE Ⅱ score (10.4±±5.4 vs.15.2±9.4,P＜0.05),significantly shorter ICU stay(days:26.6± 12.2 vs.28.1± 17.0,P＜0.01),and significantly lower 28-day mortality rate (0 vs.31.8％,P＜0.01).Conclusion The early serum levels of sex hormones may have significant influence on the prognosis in post-abdominal surgery patients with SIRS.