静脉注射免疫球蛋白加强的松龙治疗川崎病患儿,09:00 h单血清皮质醇值可作为肾上腺皮质功能的指标

IF 1 Q4 ENDOCRINOLOGY & METABOLISM Clinical Pediatric Endocrinology Pub Date : 2015-07-01 DOI:10.1297/cpe.24.69
M. Goto, N. Miyagawa, Kaori Kikunaga, M. Miura, Y. Hasegawa
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引用次数: 6

摘要

静脉注射免疫球蛋白(IVIG)联合强的松龙治疗川崎病(KD)儿童心血管并发症是有效的。然而,在该方案中,强的松龙治疗约20天会导致很大比例的治疗儿童肾上腺皮质抑制。为了建立一种简单的方法来筛查这种抑制,我们对2012年2月至2014年3月在我们机构接受该方案治疗的72名KD患儿进行了前瞻性研究。通过对2012年2月至6月治疗的21例首发患者进行ROC分析,确立了09:00 h时血清皮质醇值为5 mcg/dL作为肾上腺皮质功能完好的阈值,相当于CRH刺激试验中血清皮质醇值高于15 mcg/dL的峰值。然后,我们将该筛选试验应用于2012年7月至2014年3月期间治疗的51例后续患者。在停止初始泼尼松龙治疗2至6个月后,大约90%的患者早晨血清皮质醇值高于5微克/分升,血清皮质醇值峰值超过15微克/分升,表明这种方法的有效性。
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Single serum cortisol values at 09:00 h can be indices of adrenocortical function in children with Kawasaki disease treated with intravenous immunoglobulin plus prednisolone
Combination treatment with intravenous immunoglobulin (IVIG) plus prednisolone is effective for prevention of cardiovascular complications in children with Kawasaki disease (KD). However, administration of prednisolone for approximately 20 d in this regimen causes adrenocortical suppression in a high proportion of treated children. To establish a simple method to screen for this suppression, we performed a prospective study on 72 children with KD treated with this regimen in our institution from February 2012 to March 2014. By performing ROC analysis of 21 initial patients treated between February and June 2012, a serum cortisol value at 09:00 h of 5 mcg/dL was established as a threshold for intact adrenocortical function, which is equivalent to a peak serum cortisol value of higher than 15 mcg/dL in the CRH stimulation test. Then, we applied this screening test to 51 subsequent patients treated between July 2012 and March 2014. Approximately 90% of the patients with morning serum cortisol values above 5 mcg/dL 2 to 6 mo after the cessation of initial prednisolone treatment had peak serum cortisol values exceeding 15 mcg/dL, suggesting the efficacy of this approach.
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来源期刊
Clinical Pediatric Endocrinology
Clinical Pediatric Endocrinology ENDOCRINOLOGY & METABOLISM-
CiteScore
2.40
自引率
7.10%
发文量
34
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