tailieunhanh - Báo cáo y học: "Sepsis-related stress response: known knowns, known unknowns, and unknown unknown"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Sepsis-related stress response: known knowns, known unknowns, and unknown unknowns. | Peng and Du Critical Care 2010 14 179 http content 14 4 179 CRITICAL CARE COMMENTARY L__ Sepsis-related stress response known knowns known unknowns and unknown unknowns Jinmin Peng and Bin Du See related research by Lesur etal. http content 14 4 R131 Abstract The hypothalamic-pituitary-adrenal HPA axis response in sepsis remains to be elucidated. Apart from corticotropin-releasing hormone adrenocorticotropic hormone and cortisol many other neuroendocrine factors participate in the regulation of HPA stress response. The HPA response to acute and chronic illness exerts a biphasic profile. Tissue corticosteroid resistance may also play an important role. All of these add to the complexity of the concept of relative adrenal insufficiency and may account for the difficulty of clinical diagnosis and for the conflicting results of corticosteroid replacement therapy in severe sepsis septic shock. The study by Lesur and colleagues expands our understanding of the mechanism and further study of HPA stress response is warranted. In this issue of Critical Care Lesur and colleagues 1 report the differential profile of stress response in septic and non-septic patients. Adrenocorticotropic hormone ACTH and ACTH cortisol ratio were lower whereas baseline cortisol procalcitonin PCT and stromal cell-derived factor-1-alpha SDF-1a were higher in septic patients than in non-septic patients. Furthermore a probability score incorporating ACTH cortisol and PCT by multivariate logistic regression analysis predicted sepsis better than sepsis score or PCT did 1 . The response of hypothalamic-pituitary-adrenal HPA axis to the sustained stress of severe illness has been the focus of many studies in recent years. In healthy subjects cortisol secretion by adrenal cortex is regulated by ACTH secretion by the pituitary which in turn is regulated primarily by hypothalamic secretion of corticotropinreleasing hormone CRH whereas cortisol inhibits both Correspondence .