性类固醇激素在循环性休克、败血症综合征和感染性休克中的作用。

Circulatory shock Pub Date : 1994-08-01
F Fourrier, A Jallot, L Leclerc, M Jourdain, A Racadot, J L Chagnon, A Rime, C Chopin
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引用次数: 0

摘要

方法:对50例危重患者(男性38例,绝经后女性12例),连续10 d,每日测定雌激素(E1)、雌二醇(E2)、睾酮(T)、卵泡刺激素(FSH)、黄体生成素(LH)水平。患者分为4组:A)无循环衰竭,无脓毒症,B)脓毒症综合征,无循环衰竭,C)循环衰竭,无脓毒症综合征,D)感染性休克。比较1)4组患者、2)男女患者、3)脓毒症患者和非脓毒症患者的激素测量结果。在另外10例感染性休克患者中,通过测量基线和多巴酚丁胺输注后的皮质醇、E1和T,证实了输注血管活性药物多巴酚丁胺诱导性激素变化的可能性。活性肾素和血浆肾素活性(PRA)的变化被用作多巴酚丁胺诱导β 2刺激的间接证据。结果:B、D组女性患者E1、E2水平显著升高,仅D组男性患者出现。脓毒症患者雌激素水平在脓毒症发病后第1、2天达到峰值,6天后趋于正常,FSH、LH水平下降。幸存者和非幸存者之间没有发现差异。不管是哪一组,在整个研究过程中,男性患者的睾酮水平都很低。多巴酚丁胺诱导活性肾素水平显著升高,肾素与PRA之间的回归斜率显著降低。皮质醇水平保持正常。多巴酚丁胺后E1和T无明显变化。结论:无论是男性还是女性,在脓毒症和脓毒性休克患者中均可观察到高雌激素水平。LH和FSH水平降低与高雌激素水平对垂体分泌的负反馈作用一致。所有男性患者的循环T水平均下降。我们发现顺序雌激素水平与结果之间没有相关性。多巴酚丁胺诱导的β -2刺激并没有改变这些水平。
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Sex steroid hormones in circulatory shock, sepsis syndrome, and septic shock.

Methods: Estrone (E1), estradiol (E2), testosterone (T), FSH, and LH levels were daily measured during a ten day period in 50 critically ill patients (38 men, 12 post-menopausal women). Patients were separated into four groups: A) no circulatory failure, no sepsis, B) sepsis syndrome without circulatory failure, C) circulatory failure without sepsis syndrome, D) septic shock. Results of hormonal measurements were compared 1) among the 4 groups, 2) between male and female patients, 3) between septic and nonseptic patients. The potential for the infusion of the vasoactive drug dobutamine to induce sex hormonal changes was documented in ten additional septic shock patients by measuring cortisol, E1, and T at base-line and after dobutamine infusion. Changes in active renin and plasma renin activity (PRA) were used as indirect witness of the dobutamine-induced beta 2-stimulation.

Results: A dramatic increase in E1 and E2 levels was observed in women of groups B and D, and only in male patients of group D. In the septic patients, estrogen levels peaked at days 1 and 2 and trended to normal from day 6 after the onset of sepsis, while FSH and LH decreased. No difference was found between survivors and non-survivors. Whatever the group, male patients had low T levels throughout the study. Dobutamine induced a significant increase in active renin levels and a decrease in the regression slope between renin and PRA. Cortisol levels remained normal. No significant change in E1 and T was observed after dobutamine.

Conclusions: High estrogen levels were specifically observed in patients with sepsis and septic shock, either males or females. Decreased LH and FSH levels were consistent with the negative feed-back effect of high estrogen levels on pituitary secretion. Circulating T levels were decreased in all male patients. We found no correlation between sequential estrogen levels and outcome. These levels were not modified by a dobutamine-induced beta-2 stimulation.

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