烧伤患者血清皮质醇、醛固酮、促肾上腺皮质激素水平的变化

目的　研究烧伤对患者下丘脑 垂体 肾上腺皮质轴激素水平的影响。方法　应用放射免疫的方法检测 37例不同程度烧伤患者及 30例正常对照组血清促肾上腺皮质激素 (ACTH)、总皮质醇 (GC)、醛固酮 (ALD)的水平 ,37例不同程度烧伤患者按照烧伤指数 (BI)分为 4组 ,即烧伤Ⅰ组 (BI≤ 2 0 )、Ⅱ组 (BI为 2 1～ 30 )、Ⅲ组 (BI为 31～5 0 )、Ⅳ组 (BI≥ 5 0 )。结果　正常对照组血清ACTH(5 .0 4± 1.6 3) pmol/L、GC(2 92 .6 3± 95 .35 )nmol/L、ALD(2 0 0 .2 7± 70 .82 ) pmol/L。烧伤Ⅰ组血清GC水平与对照组比较有显著性差异 (P <0 .0 0 1) ,ACTH、ALD水平与对照组比较无显著性差异 (P >0 .0 5 ) ;烧伤Ⅱ组血清ACTH、GC、ALD水平与对照组比较无显著性差异 (P >0 .0 5 ) ;烧伤Ⅲ组和烧伤Ⅳ组血清ACTH、GC、ALD水平与对照组比较均有显著性差异 (P <0 .0 0 1) ,且ACTH、GC和ALD与BI成正相关 (rACTH=0 .95 ,P <0 .0 0 1;rGC=0 .97,P <0 .0 0 1;rALD=0 .97,P <0 .0 0 1)。结论　严重烧伤可能引起下丘脑对垂体的刺激 ,使垂体释放ACTH ,从而导致GC和ALD水平的上升 ,且下丘脑 垂体 肾上腺皮质轴激素水平与BI成密切正相关。因此 ,我们可以通过检测ACTH、GC和ALD作为严重烧伤病人治疗、病情变化和预后等的重要观察?

Changes in ACTH and total cortisol and aldosterone in serum of severe burn patients

Objective To investigate the postburn changes in hypothalamus-pituitary-adrenal hormones in severely burned patients.Methods Thirty-seven burn patients were enrolled in this study by using radio-immunological assay (RIA) method to determine the serum contents of ACTH and total GC (cortisol) and aldosterone (ALD) in the burned groups and the normal control groups.Results ①The results showed that serum contents of ACTH was( 5.04±1.63) pmol/L,total GC(536.95±326.59)nmol/L,ALD( 200.27±70.82)pmol/L,in the normal control group.②It was found that the serum contents of ACTH and total GC in the burned group I was obviously higher than that in the normal control group,which showed significant difference between the burned groups and the normal control groups(P<0.001),but there was no significant difference in the serum contents of ALD between the burned groups Ⅰ and the normal control groups(P>0.05).The serum contents of ACTH and total GC in the burned groups Ⅱwere not significantly different compared with the normal control groups(P>0.05),while the serum contents of ALD marked differently between the burned groups Ⅱ and the normal control groups (P<0.05).The serum contents of ACTH and total GC and ALD in the burned groups Ⅲ and Ⅳ indicated significant difference compared with the normal control groups (P<0.001).The serum contents of ACTH and GC and ALD in the burned groups and BI presented positive correlation. ConclusionThe severe burn injury can cause the changes of hypothalamus-pituitary-adrenal hormones,therefore,examining the serum contents of ACTH and total GC and ALD in severely burned patients can be index values to determine the treatment and prognosis in clinic.