肾上腺皮质功能状态与急性呼吸窘迫综合征患者预后关系的研究

目的探讨肾上腺皮质功能状态与急性呼吸窘迫综合征（ARDS）患者预后的关系。方法纳入2004年7月至2005年2月符合ARDS诊断标准的患者158例,以是否存活分为存活组和死亡组。静脉注射促肾上腺皮质激素250μg,放射免疫分析法测定注射前、注射后30min及60min血浆皮质醇水平（T0、T30及T60）。计算130或T60的最大值与T0的差值（△Tmax）,以ATmax≤248．4nmol／L作为相对肾上腺皮质功能不全的诊断标准。记录患者一般情况、急性生理和慢性健康（APACHEⅡ）评分、心率、呼吸、平均动脉压、氧合指数、动脉血pH、动脉血乳酸、血红蛋白、血小板和白细胞计数、功能衰竭器官个数和住院28d病死率。结果158例患者中存活72例,死亡86例,28d住院病死率为54．4％（86／158）,相对肾上腺皮质功能不全发生率为42．7％（68／158）。死亡组患者相对肾上腺皮质功能不全发生率明显高于存活组（62．8％vs19．4％,P〈0．01）。伴相对肾上腺皮质功能不全的ARDS患者病死率明显升高（76．5％vs36．8％,P〈0．01）。△Tmax判断预后的受试者操作曲线（ROC）下面积为0．655。Logistic多元回归分析显示功能衰竭器官数和相对肾上腺皮质功能不全是ARDS患者死亡的独立危险因素。结论肾上腺皮质功能状态对ARDS患者预后判断有指导价值。

Relationship between the adrenal function and the prognosis of acute respiratory distress syndrome

OBJECTIVE: To explore the relationship between the adrenal function and the prognosis of acute respiratory distress syndrome (ARDS). METHODS: One hundred and fifty-eight patients with ARDS were enrolled in this study and were divided into two groups based on the prognosis: survival group and death group. Every patient was given one shot of corticotrophin 250 microg intravenously, plasma cortisol level was detected by radio-immunoassay before the shot (T0) and 30 minutes (T30) and 60 minutes (T60) after. And meanwhile the following parameters in the patients were recorded: age, APACH II, heart rate, mean arterial pressure, PaO(2)/FiO(2), arterial pH, hemoglobin, platelets and WBC, the number of failed organ and 28-day mortality. Relative adrenal insufficiency was defined as the difference between T0 and the highest value of T30 or T60 (DeltaTmax)