Salivary Cortisol Can Replace Free Serum Cortisol Measurements in Patients With Septic Shock
Salivary Cortisol Can Replace Free Serum Cortisol Measurements in Patients With Septic Shock
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DOI：
10.1378/chest.11-0448
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发表时间：
2011-11-01
期刊：
影响因子：
9.6
通讯作者：
Orlander, Philip R.
中科院分区：
文献类型：
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作者：
Estrada-Y-Martin, Rosa M.;Orlander, Philip R.
背景：严重脓毒症时肾上腺功能重新受到关注。大多数研究使用总血清皮质醇水平;然而，只有游离血清皮质醇具有生物活性。本研究的目的是确定唾液皮质醇水平的有效性作为一个替代品，游离血清皮质醇水平在脓毒性shock.Methods：57例脓毒性休克患者进行了研究，以确定血清总皮质醇和唾液皮质醇之间的相关性，以游离血清皮质醇水平。38例患者纳入唾液与游离血清皮质醇相关性研究。采用酶免疫法测定唾液皮质醇水平。血清总皮质醇，游离皮质醇，皮质醇结合球蛋白（CBG）水平测定液相色谱-质谱法，平衡分析，放射免疫分析，respectively.Results：平均+/- SD年龄为56.6 +/- 18.5岁。57%是女性。APACHE（急性生理学和慢性健康评估）II评分中位数为26，简化急性生理学评分II中位数为61，序贯器官衰竭评估中位数为13。唾液和游离血清皮质醇水平之间的相关性为0.79（95%CI，0.63-0.89;P <0.0001）。游离血清皮质醇与总血清皮质醇水平之间的相关性为0.86（95%CI，0.78-0.92; P <0.0001）。平均+/- SD游离血清皮质醇水平为2.27 +/- 1.64 μ g/dL。平均+/- SD唾液皮质醇水平为2.60 +/- 2.69 μ g/dL。平均+/- SD总血清皮质醇水平为21.56 +/- 8.71 μ g/dL。平均+/- SD CBG水平为23.54 +/- 8.33 mg/dL.结论：唾液皮质醇水平可作为感染性休克患者游离血清皮质醇水平的替代品，具有很好的相关性。唾液皮质醇测试是非侵入性的，易于执行，可以每天进行。
Background: There is a renewed interest in adrenal function during severe sepsis. Most studies have used total serum cortisol levels; however, only free serum cortisol is biologically active. The aim of this study was to determine the validity of salivary cortisol levels as a surrogate for free serum cortisol levels during septic shock.Methods: Fifty-seven patients with septic shock were studied to determine the correlation between total serum cortisol and salivary cortisol to free serum cortisol levels. Thirty-eight patients were included in the salivary to free serum cortisol correlation. Salivary cortisol level was tested by enzyme immunoassay. Serum total cortisol, free cortisol, and cortisol-binding globulin (CBG) levels were determined by liquid chromatography-mass spectrometry, equilibrium analysis, and radioimmunoassay, respectively.Results: The mean +/- SD age was 56.6 +/- 18.5 years. Fifty-seven percent were women. APACHE (Acute Physiology and Chronic Health Evaluation) II score median was 26, Simplified Acute Physiology Score II median was 61, and Sequential Organ Failure Assessment median was 13. The correlation between salivary and free serum cortisol levels was 0.79 (95% CI, 0.63-0.89;P < .0001). The correlation between free serum cortisol and total serum cortisol levels was 0.86 (95% CI, 0.78-0.92; P < .0001). The mean +/- SD free serum cortisol level was 2.27 +/- 1.64 mu g/dL. The mean +/- SD salivary cortisol level was 2.60 +/- 2.69 mu g/dL. The mean +/- SD total serum cortisol level was 21.56 +/- 8.71 mu g/dL. The mean +/- SD CBG level was 23.54 +/- 8.33 mg/dL.Conclusions: Salivary cortisol level can be used as a surrogate of free serum cortisol level in patients with septic shock with very good correlation. Salivary cortisol testing is noninvasive, easy to perform, and can be conducted daily.