颅脑创伤型下丘脑垂体功能不全的临床研究  

Clim＇cai investigation of traumatic pituitary insufficiency after traumatic brain injury

作　　者：王天华[1] 卢刚[1] 吴旭[1] 朱飚[1] 陈书达[1] 

机构地区：[1]浙江省人民医院神经外科,杭州310014

出　　处：《中华急诊医学杂志》2008年第10期1071-1074,共4页Chinese Journal of Emergency Medicine

摘　　要：目的研究颅脑创伤（TBI）后垂体前叶激素（APHs）、甲状腺功能（TF）和生殖激素（GnH）的动态变化及其临床意义。方法随机对浙江省人民医院2006年3月至2007年6月经系列头颅CT扫描和／或MRI检查，明确无下丘脑、垂体等部位的原发损伤，且既往无中枢神经系统、内分泌和泌尿生殖系统肿瘤及免疫性疾患史的93例门急诊和住院TBI患者的APHs、TF和GnH进行测定，并按患者的GCS评分、TBI类型和损伤程度以及有无继发性脑损害等因素进行分组研究，以同期20例健康体检者作为对照组。采用SPSS11．5软件进行分析，多变量采用成组Hotelling T^2检验，两组均数间比较采用t检验，P〈0．05为差异具有统计学意义。结果93例患者入院就诊时的促。肾上腺皮质激素（ACTH）、黄体生成素（LH）和泌乳素（PRL）水平明显高于出院随访期和对照组（P〈0．05），促甲状腺素（TSH）和甲状腺激素T3、T4和游离T3（FT3）水平则明显低于出院随访期和对照组（P〈0．05）。有继发性脑损害组的血清ACTH值和PRL值分别高达（33．33±6．86）和（31．74±5．51），GCS9～12分组的血清LH值为（9．48±1．14）；颅脑损伤组的血清TSH值（1．26±0．17）明显低于对照组和其他各组（P〈0．05）。除TSH、PRL、睾酮（T）和雌二醇（E2）外，患者出院随访期其他血清APHs值均明显低于正常对照组（P〈0．05）。单项APH水平低下的创伤型下丘脑垂体功能不全（THPI）的发生率为13．8％，同时累及3种以上APHs的THPI发生率仅为3．2％；正常甲状腺功能病态综合征（SETS）的发生率为14．0％。结论THPI以单项APH分泌障碍型多见。颅脑创伤所致的急性颅内高压以及脑水肿、脑缺血等继发性脑损害可能是导致THPI的主要原因；TBI后早期的高PRL血症是提示THPI的重要指标，TBI后激素水平的动态变化可作为激素疗法的重要依据。Objective To investigate dynamic change of anterior pituitary hormones （APHs）, thyroid function （TF） and genital hormones （GnHs） in patients with traumatic brain injury （TBI） and their clinical significance. Method APHs, TF and GnH were tested in 93 patients with TBI, who were admitted to Zhejiang Provincial People＇ s Hopital from March 2006 to June 2007. Patients with primary injury in the hypothalamic and pituitary regions, as detected by CT and/or MRI examination, as well as those with tumors or immune diseases in the CNS, endocrine or urinogenital systems, were excluded. The clinical data were analyzed according to Glasgow coma scores （GCS）, type and degree of injury, and whether there was any secondary cerebral injury. Twenty healthy people acted as controls. The data were analyzed by the Hotelling T2 test and t -tests using SAS 11.5. A P value of less than 0.05 indicated statistical significance. Results The levels of adrenocorticotropic hormone （ACTH）, luteinizing hormone （LH） and prolactin （PRL） were markedly higher in all 93 TBI patients than controls, while those of thyroid-stimulating hormone （TSH）, thyroid hormone T3, T4 and FT3 were significantly lower in TBI patients in the early stage after injury than in those at follow-up and controls （P 〈 0.05）. The ACTH and PRL values reached （33.33 ± 6.86） and （31.74± 5.51 ）, respectively, and the LH value was （9.48 ± 1.14） in the secondary cerebral injury group.The TSH value （1.26± 0.17） in the brain injury group was significantly lowerthan those in controls （P 〈 0.05）. With the exception of TSH, PRL, testosterone （T） and E2, other APHs were markedly lower in TBI patients at following-up than in controls （ P 〈 0.05 ）. The incidence of traumatic hypothalamus-pituitary insufficiency （THPI） associated with low levels of more than three APHs was 3.2%, while 13.8% of THPI patients showed low levels of at least one APH. The ratio of sick euthyroid syndrome （SETS） was 14.0%. Conc

关 键 词：颅脑创伤 创伤型下丘脑垂体功能不全 垂体前叶激素 甲状腺功能 生殖激素 

分 类 号：R651.15[医药卫生—外科学]