应激状态下患者下丘脑-垂体-肾上腺轴功能的变化

目的观察急、慢性应激状态下患者下丘脑-垂体-肾上腺轴(HPA)功能的变化。方法选择2011年1月至2013年1月在东风医院外科住院的31例手术创伤患者为急性应激组,在内分泌科住院的代谢综合征患者31例为慢性应激组,同期在东风医院体检的无内分泌疾病的31例健康查体者为健康对照组。分别测定8:00、16:00及24:00血清皮质醇和促肾上腺皮质激素(ACTH)的水平。结果①急性应激组患者血清皮质醇、ACTH在不同时点间均升高,且高皮质醇与高ACTH发生率高,与健康对照组比较,差异有统计学意义(P<0.05);②慢性应激组患者血清皮质醇、ACTH在不同时点间均升高,且皮质醇与ACTH昼夜节律紊乱发生率高,与健康对照组比较,差异有统计学意义(P<0.05);③慢性应激组与急性应激组患者比较,血清皮质醇(8:00、16:00)和ACTH(8:00、24:00)均减低,差异有统计学意义(P<0.01);④相关性分析:血清皮质醇与ACTH在急、慢性应激组均呈正相关关系。结论急性应激组患者HPA分泌亢进,慢性应激组患者HPA分泌昼夜节律紊乱。

Changes of the Hypothalamic-pituitary-adrenal Axis Function under the Stress Condition

Objective To observe the changes of the hypothalamic-pituitary-adrenal （HPA） axis function under the effects of acute and chronic stress condition. Methods During Jan. 2011 and Jan. 2013 in Dongfeng Hospital,31 patients with operation wound hospitalized at the surgery department were selected as the acute stress group and 31 patients with metabolism syndrome hospitalized at the endocrinology department were selected as the chronic stress group, and 31 people for physical examination were selected as the healthy control group. Serum COR, ACTH concentration at 8：00,16：00,24：00 were tested respectively. Results （1）At different time points serum COR and ACTH in acute stress group all rose ,the incidence of high serum COR and ACTH were higher than the control gruup（P 〈0.01 ）. （2） At different time points serum COR and ACTH in chronic stress group all rose, the serum COR and ACTH secrete circadian rhythms disorder all rose, with statistically significant differences from the control group（ P 〈 0.05 ）.（3） Serum COR（ 8：00,16：00） and serum ACTH （8：00,24：00） in chronic stress group patient were all lower than those of acute stress group （P 〈 0.01 ）. @ Correlation analysis：serum COR and ACTH were positively correlated in acute stress group and chronic stress group. Conclusion HPA axis hypersecretion exists in acute stress patients, while HPA axis secretion circadian rhythms disorder exists in chronic stress patients.