基础皮质醇水平在急性不补偿性肝硬化中不能预测上腺反应
Brian J Wentworth1, Matthew Schliep2, Wendy M Novicoff3
1Division of Gastroenterology and Hepatology.
European journal of gastroenterology & hepatology
|December 22, 2023
概括
早晨的总皮质醇 (TC) 水平不能预测肝硬化患者的上腺功能障碍 (AD). 临床医生不应该在这个人群中使用隔离的早晨皮质醇作为阿尔茨海默病查工具.
科学领域:
- 内分泌学 在内分泌学.
- 肝病学 肝病学是一种肝病学.
- 内部医学 内部医学
背景情况:
- 晨间的总皮质醇 (TC) 水平已被确立为一般人群中上腺功能障碍 (AD) 的预测因素.
- 在肝硬化患者中,早晨TC水平对AD的预测价值仍未得到研究.
研究的目的:
- 评估早晨总皮质醇 (TC) 水平在预测急性不补偿性肝硬化患者的上腺功能障碍 (AD) 中的有用性.
- 为了确定基底TC水平或常见的临床参数是否预测该患者队列中的AD.
主要方法:
- 对患有急性去补偿性肝硬化的非危急病患者进行了回顾性队列研究,这些患者接受了上腺皮质激素 (ACTH) 刺激测试 (2011-2022).
- 上腺功能障碍被定义为ACTH后60分钟的TC增加 (delta TC) <9μg/dl.
- 多变量回归分析评估了AD的预测因素,包括基底TC,白蛋白和MELD得分.
主要成果:
- 包括119名患者;中位数MELD得分为18.
- 基底TC水平与deltaTC没有相关性 (P=0.591) 并不能预测AD (OR=0.991;P=0.855).
- 白蛋白水平 (OR=0.418;P=0.024) 和MELD评分 (OR=1.094;P=0.014) 是独立预测AD的.
结论:
- 基线总皮质醇水平不能预测急性不补偿性肝硬化患者的上腺皮质激素刺激测试反应.
- 隔离的早晨皮质醇结果不应用于查上腺功能障碍的肝患者的查方法.
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