脓毒症是新生儿马驹发病和死亡的主要原因。相对肾上腺功能不全(RAI),定义为皮质醇对压力的反应不足,与脓毒症有关,早产,新生小马驹的不良结局。除了皮质醇,肾上腺合成几种生物重要的类固醇和类固醇前体,包括醛固酮,雄激素,和孕激素。然而,住院期间这些激素的浓度及其与危重小马驹疾病严重程度和死亡率的关系尚未得到全面评估.我们假设,除了皮质醇和醛固酮,在危重的小马驹中,类固醇前体(孕激素和雄激素)的浓度会发生变化。我们还提出,与健康的小马驹相比,败血症的小马驹的类固醇前体浓度更高,在未存活的败血症和早产的小马驹住院期间,类固醇浓度将持续增加。年龄小于4天的马驹被归类为健康,败血症,非败血症,根据体检,早产,病史,实验室数据。入院时(0h)采集血样,24h,入院后72小时。通过免疫测定法测量类固醇和ACTH的浓度。计算每种激素住院72h(AUC0-72h)的曲线下面积。血清皮质醇,醛固酮,黄体酮,孕烯醇酮,硫酸脱氢表雄酮(DHEAS),和17α-羟孕酮浓度在败血症和早产的小马驹高于健康的小马驹在0h和整个72h的住院(P<0.05)。与健康对照组相比,败血症和早产儿入院时血浆ACTH浓度较高(P<0.05)。孕酮(AUC0-72h)的临界值为1,085ng/mL/h,高于该临界值,可以可靠地预测住院小马驹的非生存。具有82%的灵敏度和77%的特异性。重症新生儿马驹对压力有适当的反应,其特征是入院时皮质醇和类固醇前体浓度增加。在健康的小马驹中观察到类固醇浓度迅速下降。然而,孕激素和雄激素浓度持续升高与病程改善和预后不良相关.
Sepsis is a major cause of morbidity and mortality in neonatal foals. Relative adrenal insufficiency (RAI), defined as an inadequate cortisol response to stress, has been associated with sepsis, prematurity, and poor outcome in newborn foals. In addition to cortisol, the adrenal gland synthesizes several biologically important steroids and steroid precursors, including aldosterone, androgens, and progestogens. However, concentration of these hormones during hospitalization and their association with the severity of disease and mortality in critically ill foals have not been completely evaluated. We hypothesized, that in addition to cortisol and aldosterone, concentration of steroid precursors (progestogens and androgens) will be altered in critically ill foals. We also proposed that septic foals will have higher concentrations of steroid precursors than healthy foals, and steroid concentrations will be persistently increased during hospitalization in non-surviving septic and premature foals. Foals <4 days of age were categorized as healthy, septic, sick non-septic, and premature based on physical exam, medical history, and laboratory data. Blood samples were collected on admission (0 h), 24 h, and 72 h after admission. Concentrations of steroids and ACTH were measured by immunoassays. The area under the curve over 72 h (AUC0-72h) of hospitalization was calculated for each hormone. Serum cortisol, aldosterone, progesterone, pregnenolone, dehydroepiandrosterone sulfate (DHEAS), and 17 α-hydroxyprogesterone concentrations were higher in septic and premature foals compared to healthy foals at 0 h and throughout 72 h of hospitalization (P < 0.05). Plasma ACTH concentrations were higher in septic and premature foals on admission compared to healthy controls (P < 0.05). The progesterone (AUC0-72h) cut-off value above which non-survival could be reliably predicted in hospitalized foals was 1,085 ng/mL/h, with 82% sensitivity and 77% specificity. Critically ill neonatal foals had an appropriate response to stress characterized by increased concentrations of cortisol and steroid precursors on admission. A rapid decline in steroid concentration was observed in healthy foals. However, persistently elevated progestogen and androgen concentrations were associated with a lack of improvement in the course of disease and poor outcome.