Patterns of corticosteroid-binding globulin and the free cortisol index during septic shock and multitrauma
Patterns of corticosteroid-binding globulin and the free cortisol index during septic shock and multitrauma
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DOI：
10.1007/s001340101073
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发表时间：
2001-10-01
影响因子：
38.9
通讯作者：
Vermes, I
中科院分区：
文献类型：
--
作者：
Beishuizen, A;Thijs, LG;Vermes, I
目的：研究急性和长期危重病患者血清皮质醇结合球蛋白(CBG)和游离皮质醇指数(FCI)与总皮质醇和促肾上腺皮质激素(ACTH)浓度的时程关系。设计：前瞻性临床研究。地点：20个床位的内外科重症监护室。患者和参与者：感染性休克患者30例，多发伤患者8例，健康对照组40例。测量和结果：在14天内或出院/死亡期间，连续测定血清CBG、皮质醇、肿瘤坏死因子-α、IL-6、血浆ACTH免疫活性和FCI(=皮质醇/CBG×100)。我们还记录了血流动力学参数、APACHE II、ISS、SOFA评分、休克持续时间、肌力调节剂的使用和ICU死亡率。两组早期(感染性休克：17.5+/-5.9，创伤：16.1+/-2.3 mg/L)较对照组(37.3+/-5.3 mg/L)明显降低。早期的FCI很高(感染性休克：7.2+/-2.7；创伤：6.5+/-1.3；对照组：1.25+/-0.76)。在随访期间，CBG水平显著升高，从第7天开始恢复到正常水平。FCI显示出相反的双相模式，在第二阶段FCI值接近正常化。回归分析显示CBG与IL-6水平呈负相关(r(S)=-0.63；P<；0.05)，但与病情严重程度、休克时间及死亡无关。结论：感染性休克及多发伤早期CBG水平极低。这些戏剧性的变化反映在伴随着更高的FCI，表明更高的游离皮质醇水平。第二阶段显示CBG水平升高和正常化，与临床参数无关。我们认为，CBG在糖皮质激素对严重应激的反应中发挥积极作用，并在调节皮质醇对靶组织的可用性方面发挥积极作用。
Objective: To study the time course of corticosteroid binding-globulin (CBG) level and the free cortisol index (FCI) in comparison with total cortisol and ACTH concentrations during acute and prolonged critical illness.Design: Prospective observational clinical study.Setting: Twenty-bed medical/surgical intensive care unit.Patients and participants: Thirty patients with septic shock, eight patients with multitrauma, and forty healthy control subjects.Measurements and results: During 14 days or until discharge/death, we serially measured serum concentrations of CBG, cortisol, TNF-alpha, IL-6, plasma ACTH immunoreactivity, and the FCI (= cortisol/CBG x 100). We also recorded haemodynamic parameters, APACHE II, ISS, SOFA scores, shock duration, inotrope use, and ICU mortality. In both groups we found markedly decreased CBG levels in the early phase (septic shock: 17.5 +/- 5.9, and trauma: 16.1 +/- 2.3 mg/l) in comparison with controls (37.3 +/- 5.3 mg/l). The FCI was high in this early phase (septic shock: 7.2 +/- 2.7; trauma: 6.5 +/- 1.3, controls: 1.25 +/- 0.76). During follow-up, CBG levels significantly increased, reaching normal levels from day 7 on. The FCI showed an opposite biphasic pattern, with near-normalising FCI values during the second phase. Regression analysis showed a negative correlation between CBG and IL-6 levels (r(s) = -0.63; P < 0.05), but no relation between CBG concentrations and disease severity, shock duration or death was found.Conclusions: We found extremely low CBG levels in early stage septic shock and multitrauma. These dramatic changes are reflected in a concomitant higher FCI, indicating a higher free cortisol level. A second phase displays increasing and normalising CBG levels, independent from clinical parameters. We believe that CBG plays an active role in the glucocorticoid response to severe stress and in the regulation of cortisol availability to target tissues.