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首页> 外文期刊>Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies >Cortisol-binding globulin: More than just a carrier?
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Cortisol-binding globulin: More than just a carrier?

机译：皮质醇结合球蛋白：不仅仅是载体？

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摘要

Over the past few years there has been growing interest in the function of the hypotha-lamic-pituitary-adrenal (HPA) axis in children undergoing cardiac surgery. This interest was driven, among other factors, by the facts that hemodynamic instability in the postoperative period is associated with worsened clinical outcome and that HPA axis integrity is essential to maintain hemodynamic stability during homeostasis and in response to stress. So far, studies have focused on the diagnosis of adrenal insufficiency-the most studied form of HPA axis dysfunction-using criteria developed in noncritically ill children or in adults with sepsis. Most of these studies failed to establish a link between HPA dysfunction and worsened outcome of children undergoing cardiac surgery (1, 2). There are some particularities of the postoperative cardiac population that could explain these findings. Cardiac surgery is a major stressor and should activate the HPA axis response to stress. Therefore, patients undergoing cardiac surgery are expected to have "high cortisol levels." Since we do not know what the appropriate cortisol level in response to cardiac surgery is, we cannot use baseline (or random) cortisol to assess HPA activity. This problem is also found in other critical illnesses, such as sepsis.
机译：在过去的几年中，对进行心脏手术的儿童的下丘脑-垂体-肾上腺（HPA）轴的功能越来越感兴趣。除其他因素外，这种兴趣是由以下事实引起的：术后期间的血流动力学不稳定与临床结果恶化相关，并且HPA轴完整性对于维持动态平衡和应激反应中的血流动力学稳定性至关重要。到目前为止，研究集中在肾上腺功能不全的诊断上，这是在非危重症儿童或败血症成人中制定的使用最多的HPA轴功能障碍的标准。这些研究中的大多数未能在HPA功能障碍与接受心脏手术的儿童的预后恶化之间建立联系（1、2）。术后心脏人口的某些特征可以解释这些发现。心脏手术是主要的压力源，应激活HPA轴对压力的反应。因此，进行心脏手术的患者有望具有“高皮质醇水平”。由于我们不知道响应心脏手术的合适皮质醇水平是多少，因此我们不能使用基线（或随机）皮质醇评估HPA活性。在其他严重疾病（如败血症）中也发现了此问题。

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