临床相关因素对早产儿血清皮质醇水平的影响

目的:以早产儿血清皮质醇水平作为监测指标,观察不同临床因素对皮质醇水平变化的影响.方法:出生72 h内转入湖南省儿童医院新生儿科的早产儿90例(胎龄＜37周),排除遗传代谢性疾病,母孕期及惠儿出生时均未用过肾上腺皮质激素,全部患儿在入院时(生后72 h内)静脉采血,留取血标本,分离血清,采用放射免疫法检测血清皮质醇水平.结果:危重细早产儿血清皮质醇水平高于非危重组(t=2.601,P＜0.05),机械通气组早产儿皮质醇水平显著高于非机械通气组(t=3.134,P＜0.01),低出生体重组早产儿皮质醇水平低于正常体重组(t=2.194,P＜0.05)；不同分娩方式、不同胎龄、有无低血糖、有无消化道出血、有无低血压组间皮质醇水平比较,差异均无统计学意义(P＞0.05).结论:早产儿应激发生时机体已具有调节度质醇分泌的能力,血清皮质醇浓度增高与其成熟度、病情危重程度有关.

The Effects of Clinical Factors on Cortisol in Preterm Infants

Objective: To investigate the effects of clinical factors on preterm infant’s hypothalamus-pituitary-adrenal(HPA) axis and monitor serum concentration of cortisol as index.Methods: Ninety preterm infants transferred to our hospital within 72 hours after birth,excluding genetic metabolic diseases and the application of GC during prenatal period,were chosen and their blood samples were collected within 72 hours after birth and serum cortisol were measured by radio immunoassay method.Results: The serum cortisol concentration on critically ill infants was significantly higher than that on non-critically ill infants(t=2.601,P<0.05).The serum cortisol concentration on mechanical ventilation infants was significantly higher than that on non-mechanical ventilation infants(t=3.134,P<0.01).The serum cortisol concentration on low birth weight infants was significantly lower than that on normal birth weight infants(t=2.194,P<0.05).While compared with different delivery style,different gestational age,whether had glucose metabolism disorder,gastrointestinal hemorrhage,or low blood pressure,the difference of serum cortisol concentration was not statistically significant(P>0.05).Conclusions: The preterm infant already has the ability to response stress by regulating cortisol secretion.The increase of serum cortisol concentration is correlated with the maturity of infants and the severity of the disease.