小剂量依托咪酯输注是在重症监护室外治疗重症库欣综合征的有效且安全的方法

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小剂量依托咪酯输注是在重症监护室外治疗重症库欣综合征有效且安全的方法

翻译：冯玉蓉  编辑：冯玉蓉  审校：曹莹

背景：静脉滴注依托咪酯可有效快速降低重症监护室(ICU)内重症库欣综合征(CS)患者的皮质醇水平。最近，有研究提出可在非ICU病房内小剂量使用依托咪酯治疗CS，但目前尚不清楚该方法与ICU内治疗效果相比如何。

方法：我们比较了在ICU内接受高起始剂量依托咪酯治疗(中位数:0.30 mg/kg BW/day)和在非ICU病房内接受低起始剂量依托咪酯治疗(中位数:0.025 mg/kg BW/day)的重症CS患者的数据。

结果：本研究纳入了14名患者，其中10例采用低起始剂量依托咪酯(LD)治疗，4例采用高起始剂量依托咪酯(HD)治疗。所有患者均患有与肾上腺癌（n = 8）或ACTH异位分泌（n = 6）相关的严重并发CS。两组患者使用的依托咪酯均能有效地将皮质醇水平降低到500 nmol/L以下，HD组下降时间中位数为1天，而LD组为3天（P = 0.013）。然而，HD组所有患者均出现依托咪酯引起的皮质醇不足，需要频繁监测，而LD组患者不需要额外补充氢化可的松。两组均无患者死于CS或依托咪酯引起的并发症，但在随访期间，LD组6名患者和HD组4名患者全部死于癌症，最终结果较差。

结论：我们的研究表明，对于不需要强化器官支持治疗的重症CS患者，可考虑在内科病房中使用极低剂量的依托咪酯。

原始文献来源： Constantinescu SM, Driessens N, Lefebvre A, et al. Etomidate infusion at low doses is an effective and safe treatment for severe Cushing's syndrome outside intensive care[J]. Eur. J. Endocrinol. 2020 Aug;183(2). DOI：10.1530/EJE-20-0380  

Etomidate infusion at low doses is an effective and safe treatment for severe Cushing's syndrome outside intensive care

Abstract

Introduction  Intravenous etomidate infusion is effective to rapidly lower cortisol levels in severe Cushing’s syndrome (CS) in the intensive care unit (ICU). Recently, etomidate treatment has also been proposed at lower doses in non-ICU wards, but it is not yet clear how this approach compares to ICU treatment.

Methods  We compared data from patients with severe CS treated with high starting doses of etomidate (median: 0.30 mg/kg BW/day) in ICU or with lower starting doses (median: 0.025 mg/kg BW/day) in non-ICU medical wards.

Results  Fourteen patients were included, among which ten were treated with low starting doses (LD) and four with high starting doses etomidate (HD). All patients had severe and complicated CS related to adrenal carcinoma (n = 8) or ectopic ACTH secretion (n = 6). Etomidate was effective in reducing cortisol levels below 500 nmol/L in a median of 1 day in the HD group compared to 3 days in the LD group (P = 0.013). However, all patients of the HD group had etomidate-induced cortisol insufficiency and needed frequent monitoring, while no patient from the LD group required hydrocortisone supplementation. No patient in either group died from complications of CS or etomidate treatment, but final outcome was poor as six patients in the LD group and all four patients in the HD group died from their cancer during follow-up.

Conclusion  Our study suggests that, for patients with severe CS who do not require intensive organ-supporting therapy, the use of very low doses of etomidate in medical wards should be considered.

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