颅脑创伤患者早期腺垂体激素变化及其与预后的关系  

Serum level of pituitary hormones in patients with acute phase of traumatic brain injury and its relation to prognosis

作　　者：杨渭林 冯亚萍 黄礼明[2] 吴旭[2] 王天华[2] 卢刚[2] 

机构地区：[1]富阳市人民医院神经外科,311400 [2]浙江省人民医院神经外科

出　　处：《浙江医学》2013年第9期751-753,共3页Zhejiang Medical Journal

基　　金：富阳市科技局基金项目(2007B41)

摘　　要：目的探讨颅脑创伤患者早期腺垂体激素水平的变化与颅脑创伤严重程度的关系及其对预后的影响。方法选取87例颅脑创伤患者,按入院时的GCS评分分为轻度颅脑损伤组(31例)和中-重度颅脑损伤组(56例)。采用放射免疫法测定两组患者伤后24h内的血清腺垂体激素水平,比较分析血清腺垂体激素水平含量的差异及其预后。结果颅脑创伤患者伤后24h血清肾上腺皮质激素(ACTH)、生长激素(GH)、卵泡刺激素(FSH)和泌乳素(PRL)值均明显高于对照组(均P<0.05),而且中-重度颅脑损伤组患者血清ACTH、FSH值均明显高于轻度颅脑损伤组(P<0.05)。轻度颅脑创伤组17例(54.8%)预后良好,中-重度颅脑损伤组21例(37.5%)预后良好,差异有统计学意义(P<0.05)。血清ACTH、FSH值均与GOS预后评分明显负相关(P<0.05或0.01),以伤后24h血清ACTH值≥16.84pg/ml作为推测患者预后不良的指标,其灵敏度为0.83,特异度为0.49;以伤后24h血清FSH值≥17.95U/L作为推测患者预后不良的指标,其灵敏度为0.78,特异度为0.61。结论颅脑创伤患者伤后24h内血清ACTH、GH、FSH和PRL水平明显升高,其中血清ACTH和FSH水平升高与患者的颅脑损伤程度及预后有关。Objective To investigate the serum level of pituitary hormones in patients with acute phase of traumatic brain injury （TBI） and its relation to the severity and prognosis of the disease. Methods Eighty seven patients with TBI were divided into mild injury group and moderate-to-severe group by GCS score at admission. The serum level of pituitary hormones was ex- amined by radioimmunoassay within 24h of TBI and at 6 months after TBI. The correlation of serum pituitary hormones levels with the severity and prognosis of the disease was analyzed. Results The serum levels of ACTH, GH, FSH and PRL in patients of two groups were elevated significantly within 24h after TBI compared with those in normal control group（P〈0.05） and the serum lev- els of ACTH and FSH in patients of moderate-to-severe group were higher than those in mild injury group（P〈0.05）. Meanwhile, the serum levels of ACTH and FSH were significantly correlated with the GOS scores of patients at the time of discharge （P〈 0.05 and 0.01, respectively）. The sensitivity and specificity of ACTH at cut-off value of ≥ 16.84pg/ml for predicting the poor out-comes of patients with TBI were 0.83 and 0.49 respectively, and the sensitivity and specificity of FSH at cut-off value of ≥17.95U/L were 0.78 and 0.61 respectively. Conclusion The serum levels of ACTH, GH, FSH and PRL are elevated significantly in patients with TBI. The elevated serum levels of ACTH and FSH are significantly correlated with the severity of TBI and the prognosis of patients.

关 键 词：颅脑创伤 腺垂体激素 预后 

分 类 号：R651.15[医药卫生—外科学]