Objective To investigate the changes in serum cortisol and adrenocorticotrophic hormone(ACTH) levels in children with steroid-sensitive nephritic syndrome (SSNS) and the clinical significance of intervention.Methods According to whether a child with SSNS would relapse,48 children with SSNS were divided into non-recurrence group(n =19) and recurrence group(n =29),at the same time 14 age-matched healthy children were enrolled as the healthy control group.Serum cortisol and ACTH were measured in patients with SSNS by using electrochemiluminesence methods.In recurrence group,methylpredisolone or methylprednisolone combined with ACTH injection therapy was used on 15 patients with their serum cortisol and ACTH below normal.Results Before standard glucocorticoid treatment,the serum levels of cortisol and ACTH had no difference among 3 groups (all P ＞ 0.05).By the end of remission phase,the serum levels of cortisol and ACTH in recurrence group were statistically lower than those of the non-recurrence group[(113.03 ± 80.02) μg/L vs (251.54 ± 185.05) μg/L,t =-2.925,P ＜ 0.05 ; (12.81 ± 10.14) ng/L vs (23.53 ± 12.05) ng/L,t =-0.885,P ＜ 0.05].Eight to 12 weeks after being adjusted,the serum level of cortisol and the average monthly time of recurrent were both significantly improved in 15 abnormal children in recurrence group [(168.90 ± 133.43) μg/L vs (73.62 ± 58.04) μg/L,t =3.016,P ＜ 0.05 ; (0.09 ± 0.08) times vs (0.35 ± 0.11) times,t =-7.560,P ＜0.05],but as to the serum level of ACTH,there was no significant difference in abnormal children in recurrence group [(14.05 ± 10.99) ng/L vs (8.72 ± 4.11) ng/L,t =1.991,P ＞ 0.05].Conclusions The concentrations of serum cortisol and ACTH can reveal the risk of recurrence for children with SSNS to some extent,and effective intervention can reduce the recurrence rate and shorten the course of disease.%目的 研究激素敏感型肾病综合征(SSNS)患儿血清皮质醇和促皮质素(ACTH)的变化及对其干预的临床意义.方法 将48例SSNS患儿根据其在病程中有无复发分为未复发组(例数=19)及复发组(例数=29),同时选取同龄健康儿童作为健康对照组(例数=14).采用电化学发光法测定SSNS患儿血清皮质醇和ACTH的水平,并对复发组中血清皮质醇、ACTH降低的15例患儿调整治疗方案为甲泼尼龙片或甲泼尼龙片联合ACTH针静脉滴注.结果 糖皮质激素治疗前,复发组、未复发组及健康对照组血清皮质醇、ACTH水平差异均无统计学意义(P均＞0.05);糖皮质激素诱导缓解治疗后,复发组血清皮质醇、ACTH水平均显著低于未复发组,差异均有统计学意义[(113.03±80.02) μg/L比(251.54±185.05) μg,/L,t=-2.925,P＜0.05;(12.81±10.14) ng/L比(23.53±12.05) ng/L,t=-0.885,P＜0.05];其中复发组15例患儿血清皮质醇、ACTH出现降低,调整治疗方案治疗8～12周后,血清皮质醇水平较调整治疗方案前升高,差异有统计学意义[(168.90±133.43) μg/L比(73.62-±58.04) μg/L,t =3.016,P＜0.05];血清ACTH水平调整治疗方案前后比较差异无统计学意义[(14.05±10.99) ng/L比(8.72±4.11) ng/L,t=1.991,P＞0.05];月平均复发次数较调整治疗方案前降低,差异有统计学意义[(0.09±0.08)次比(0.35±0.11)次,t=-7.560,P＜0.05].结论 血清皮质醇、ACTH的水平在一定程度上可评估SSNS患儿复发的风险,对其进行有效干预可减少其复发率.
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