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目的:通过检测脓毒症患者血浆皮质醇(Cor)水平变化,分析其与SOFA的相关性,探讨其对脓毒症患者预后作用的评估价值。方法:脓毒症患者55例,健康体检者60例为对照组,入院24小时内分别检测其血浆Cor、ACTH水平、降钙素原(PCT)、血乳酸(LAC);按照脓毒症相关的序贯器官衰竭评分(sequential(sepsisrelated)organ failure assessment,SOFA)标准对脓毒症患者进行评分,比较两组患者血浆Cor水平变化。根据脓毒症患者预后分为生存组和死亡组,比较两组血浆Cor、ACTH水平变化;分析Cor水平与SOFA、PCT、LAC、MAP之间的相关性。结果:(1)脓毒症患者血浆Cor、ACTH分别高于对照组(P<0.05);(2)脓毒症患者死亡组血浆Cor、ACTH水平及SOFA显著高于生存组(P<0.05)。(3)脓毒症患者血浆Cor水平与PCT、LAC、SOFA呈正相关;与MAP呈负相关(P<0.05)。结论:脓毒症患者发病早期机体激活下丘脑-垂体-肾上腺素轴,血浆Cor、ACTH水平明显升高。血浆Cor水平与SOFA呈正相关。
OBJECTIVE: To investigate the correlation between plasma levels of cortisol (COR) and SOFA in patients with sepsis and evaluate its prognostic value in patients with sepsis. Methods: 55 patients with sepsis and 60 healthy controls were selected as control group. Cor, ACTH, PCT and LAC were measured within 24 hours after admission. According to sepsis The sepsis-dependent organ failure assessment (SOFA) criteria were used to assess sepsis patients. Plasma Cor levels were compared between the two groups. According to the prognosis of patients with sepsis, the patients were divided into survival group and death group. The levels of Cor and ACTH in plasma were compared. The correlation between Cor levels and SOFA, PCT, LAC and MAP was analyzed. (2) Cor, ACTH and SOFA in the death group were significantly higher than those in the survival group (P <0.05); (2) The levels of Cor, ACTH and SOFA in the septic group were significantly higher than those in the control group . (3) Plasma Cor levels in patients with sepsis were positively correlated with PCT, LAC and SOFA, but negatively correlated with MAP (P <0.05). CONCLUSIONS: In sepsis patients, the activation of the hypothalamus-pituitary-adrenal axis and the plasma levels of Cor and ACTH are significantly increased in the early onset of sepsis. Plasma Cor levels were positively correlated with SOFA.