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目的观察呼吸窘迫综合征(RDS)早产儿在疾病不同时期血浆皮质醇、促皮质素(ACTH)水平的变化。方法采集本院新生儿重症监护病房的28～34周早产儿49例(RDS组20例,对照组29例),均排除遗传代谢性疾病,母孕期及早产儿出生时均未用过糖皮质激素。全部患儿分别在日龄1 d、4 d、10 d静脉采血2 mL,留取血标本,分离血浆,通过Roche Elecsys全自动电化学发光免疫分析仪分别检测其血浆皮质醇、ACTH水平。对其3个时间点血浆皮质醇、ACTH水平进行比较。结果 1.RDS组3个时间点血浆皮质醇水平均高于对照组(F=17.518、9.909、8.208,Pa<0.05)。2.RDS组内3个时间点血浆皮质醇水平之间比较,差异有统计学意义(F=26.112,P<0.05),且随时间呈下降趋势。3.RDS组和对照组之间血浆皮质醇整体水平比较,RDS组高于对照组(F=21.375,P<0.05)。4.RDS组和对照组3个时间点血浆ACTH水平比较,差异均无统计学意义(F=1.045、0.571、0.217,Pa>0.05)。5.RDS组内3个时间点血浆ACTH整体水平比较,差异无统计学意义(F=0.166,P>0.05)。6.RDS组和对照组之间血浆ACTH水平比较,差异无统计学意义(F=0.080,P>0.05)。结论在早产儿RDS中,血浆皮质醇水平增高与RDS的严重程度及病情发展密切相关。RDS早产儿血浆ACTH水平与疾病的严重程度及病情发展无明显相关。
Objective To observe the changes of plasma cortisol and corticotropin (ACTH) levels in preterm infants with respiratory distress syndrome (RDS) at different stages of the disease. Methods Forty-nine preterm infants (28 in RDS group and 29 in control group) were collected from 28 to 34 weeks of neonatal intensive care unit in our hospital. All of them were excluded from the genetic metabolic diseases. No prenatal or prenatal glucocorticoid . All children were given 2 mL blood samples on days 1, 4, and 10, respectively. Blood samples were taken and plasma was separated. Plasma Cortisol and ACTH levels were measured by Roche Elecsys automatic electro-chemiluminescence immunoassay analyzer. Plasma Cortisol and ACTH levels were compared at three time points. Results 1. The levels of plasma cortisol in RDS group were higher than those in control group at 3 time points (F = 17.518, 9.909, 8.208, Pa <0.05). The levels of plasma cortisol at 3 time points in RDS group were significantly different (F = 26.112, P <0.05), and decreased with time. RDS group and control group, the overall level of plasma cortisol, RDS group was higher than the control group (F = 21.375, P <0.05). There was no significant difference in plasma ACTH levels between RDS group and control group at 3 time points (F = 1.045,0.571,0.217, Pa> 0.05). There was no significant difference in the overall level of plasma ACTH at 3 time points in RDS group (F = 0.166, P> 0.05). There was no significant difference in plasma ACTH levels between RDS group and control group (F = 0.080, P> 0.05). Conclusion RDS in preterm children, plasma cortisol levels increased with the severity of RDS and progression of the disease are closely related. RDS premature plasma ACTH levels and disease severity and progression of the disease was not significantly correlated.