Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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Significance of Corticosteroids and Their Relationship with Other Parameters in Patients with Sepsis

패혈증에서 혈중 스테로이드의 의의 및 기타 혈중 지표와의 연관성

  • Lee, Keu Sung (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine) ;
  • Baik, Seung Hee (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine) ;
  • Lee, Hyoung No (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine) ;
  • Park, Joo Hun (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine) ;
  • Oh, Yoon Jung (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine) ;
  • Sheen, Seung Soo (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine) ;
  • Choi, Young Hwa (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine) ;
  • Park, Kwang Joo (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine) ;
  • Hwang, Sung Chul (Department of Pulmonary and Critical care Medicine, Ajou University, School of Medicine)
  • 이규성 (아주대학교 의과대학 호흡기내과학교실) ;
  • 백승희 (아주대학교 의과대학 호흡기내과학교실) ;
  • 이형노 (아주대학교 의과대학 호흡기내과학교실) ;
  • 박주헌 (아주대학교 의과대학 호흡기내과학교실) ;
  • 오윤정 (아주대학교 의과대학 호흡기내과학교실) ;
  • 신승수 (아주대학교 의과대학 호흡기내과학교실) ;
  • 최영화 (아주대학교 의과대학 호흡기내과학교실) ;
  • 박광주 (아주대학교 의과대학 호흡기내과학교실) ;
  • 황성철 (아주대학교 의과대학 호흡기내과학교실)
  • Received : 2006.07.28
  • Accepted : 2006.09.19
  • Published : 2006.10.30
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Abstract

Background: Corticosteroids are known to be significant prognostic parameters in sepsis. Recently, an absolute and relative insufficiency of the corticosteroids system has often been reported to often develop particularly in severe sepsis. Degree of such an adrenal insufficiency not only has prognostic implications but also can be used to guide corticosteroids replacement therapy. The 24-hour urinary cortisol levels as well as serum cortisol concentrations were measured to assess the clinical significance and their relationship with the other parameters of sepsis, and also evaluated the clinical implications of the relative adrenal insufficiency. Methods: 26 consecutive patients with sepsis were enrolled. The basal random serum cortisol, ACTH, ADH, lactate levels and 24-hour urinary free cortisol amount were measured. The rapid ACTH ($250{\mu}g$) stimulation test was also performed. Results: Basal serum cortisol levels were higher in the non-survivors than in the survivors. The 24-hour urinary free cortisol levels were higher in the patients with severe sepsis than in those without. The serum cortisol levels strongly correlated with the serum ADH and lactate levels. The 24-hour urinary free cortisol levels strongly correlated with the serum cortisol and lactate levels. The fractional changes in the cortisol levels after the rapid ACTH stimulation tests correlated with the serum cortisol, ADH, and lactate levels. Conclusion: Both the serum cortisol and 24-hour urinary cortisol were found to be significant prognostic factors in sepsis, and showed a strong correlation with the other parameters. The relative adrenal insufficiency might also be an important clinical parameter.

연구배경: 패혈증에서 혈중 스테로이드 농도는 유의한 예후인자로서 알려져 있다. 또한 최근에는 이러한 스테로이드의 절대적 및 상대적 결핍 현상이 알려지고 있으며, 이는 스테로이드 보충 치료의 지표로도 이용되고 있다. 본 연구에서는 패혈증 환자에서 혈중 스테로이드 농도, 24시간 뇨 스테로이드 양 및 상대적 부신결핍의 임상적 의의와 기타 패혈증의 혈중 지표와의 연관성에 대하여 알아보고자 하였다. 방 법: 패혈증 환자 26예를 대상으로 초기 혈중 스테로이드와 ACTH, ADH, lactate 등의 농도를 측정하고 24시간 뇨 유리 코티졸 양을 측정하였으며, rapid ACTH stimulation test를 시행하였다. 결 과: 패혈증 환자들에서 사망군은 생존군에 비해 기저 무작위 혈청 코티졸 농도가 유의하게 증가되어 있었다. 중증패혈증 환자들에서 24시간 뇨 유리 코티졸은 경증패혈증 환자군에 비해 유의하게 증가되어 있었다. 혈청 코티졸 농도는 ADH, lactate농도와 유의한 상관관계를 나타내었고, 24시간 뇨 유리 코티졸은 혈청 코티졸, lactate 농도와 유의한 상관관계를 보였다. 상대적 부신결핍의 정도는 혈청 코티졸, ADH, lactate 농도와 상관성이 있었다. 결 론: 패혈증 환자들에서 혈청 코티졸 농도 및 24시간 뇨 유리 코티졸은 유의한 예후평가인자로서 나타났으며, 기타 예후 인자들과 유의한 상관성을 보였다. 상대적 부신 결핍의 정도도 유의한 중증도의 지표로 나타났다.

Keywords

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