在儿科心脏外科手术期间的亲opiomelanocortin和ACTH-cortisol解离
Arno Téblick1, Ilse Vanhorebeek2, Inge Derese3
1A Téblick, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven University, B-3000 Leuven, Belgium., KU Leuven, Leuven, Belgium.
Endocrine connections
|April 24, 2024
概括
在小儿心脏外科手术患者中,手术前前期的亲opiomelanocortin (POMC) 高. 手术后,上皮质激素 (ACTH) 水平受到抑制,特别是在使用葡萄糖皮质激素治疗时.
科学领域:
- 内分泌学 在内分泌学.
- 儿科重症监护 儿科重症监护
- 激素调节 激素调节 激素调节
背景情况:
- 危急病的成年人表现出高皮质醇,低ACTH和高POMC.
- 葡萄糖皮质类药物可以降低成年人中的ACTH,但不能降低POMC.
- 儿童心脏手术诱导危急疾病,影响HPA轴.
研究的目的:
- 在接受心脏手术的儿科患者中检查亲opiomelanocortin (POMC) 和 adrenocorticotropic激素 (ACTH) 水平.
- 确定葡萄糖皮质类药物对该人群POMC和ACTH水平的影响.
- 探索中心激活的HPA轴与改变的垂体处理的假设.
主要方法:
- 53名儿科患者 (0-36个月) 的血样本在手术前,手术期间和手术后的第一天和第二天收集.
- 还从24名健康儿童收集了血样本进行比较.
- 血POMC和ACTH水平的量化.
主要成果:
- 患者在手术前表现出超正常的POMC (p<0.0001),在手术后正常化 (p<0.05).
- 患者的ACTH水平没有升高;在未服用葡萄糖皮质激素的患者 (p<0.0001) 中,它们在术后第一天被抑制.
- 接受葡萄糖皮质激素治疗的患者在手术期间表现出抑制的ACTH (p≤0.0001),这表明抑制加速.
结论:
- 在没有增加ACTH的情况下POMC的手术前升高表明儿童心脏手术患者的中心HPA轴激活和降低垂体POMC处理.
- 葡萄糖皮质类药物治疗在这些重症儿童中加速了ACTH抑制.
- 研究结果强调了与成年人相比,儿科重症患者的HPA轴动态不同.
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