重度颅脑创伤恢复期患者生长激素替代治疗对认知功能的影响  

Effectiveness of recombinant human growth hormone replacement on cognitive impairment in patients with adult growth hormone deficiency and chronic severe traumatic brain injury

作　　者：王晓艳[1] 侯亚静[2] 张皓[1] 迟茜茜[1] 张小年[1] 

机构地区：[1]中国康复研究中心北京博爱医院,首都医科大学康复医学院 [2]首都医科大学附属复兴医院

出　　处：《中国康复医学杂志》2014年第5期437-441,共5页Chinese Journal of Rehabilitation Medicine

基　　金：中央级公益性科研院所基本科研业务费专项资金(2011-CZ-6)

摘　　要：目的:考察重度颅脑创伤(TBI)恢复期患者生长激素替代治疗对认知功能的影响。方法:选择重度TBI恢复期的男性患者为研究对象,通过GH激发试验确诊为GH缺乏或不足,随机分为对照组和试验组,对照组给予常规治疗,试验组给予常规治疗和小剂量rhGH的替代治疗。在治疗前对所有患者进行神经心理学量表(MoCA和LOTCA)评定,治疗后第1、2、3个月时分别再次进行神经心理学量表评定。结果:①组内对比:对照组和试验组治疗后的MoCA[(13.4±6.8)vs(19.5±5),(17.1±5.9)vs(26.8±2.9)]和LOTCA[(57.7±10.4)vs(67.1±13),(68.8±10.2)vs(84.3±2.7)]评分随时间均有一定程度改善。②组间对比:试验组在治疗后1—3个月,LOTCA评分较对照组更高,其差异有显著性意义(P<0.05),但MoCA评分试验组与对照组无显著性差异(P>0.05)。③在MoCA和LOTCA的分项评分上,组间对比:试验组在视运动、视空间与执行能力、注意力和记忆力4方面较对照组有明显改善,差异有显著性意义。组内对比:对照组和试验组治疗后的定向力、知觉、视运动、思维运作、视空间与执行能力、注意力各项目得分均有改善,但对照组的记忆力在治疗后无明显改善。结论:合并有生长激素缺乏或不足的重度TBI患者,在常规康复治疗的基础上,进行3个月小剂量rhGH替代治疗,可进一步改善患者的视运动、视空间与执行能力、注意力、记忆力等方面的认知功能。Objective： To investigate the effectiveness of recombinant human growth hormone （rhGH） replacement on cog- nitive impairment in patients with adult growth hormone deficiency （GHD） and chronic severe traumatic brain injury （TBI）. Method： Nineteen male patients with chronic severe TBI were included, their GHD was confirmed through GH provocative test. The patients were randomly divided into control group and treatment group, receiving just conventional treatment and extra low dose of GH respectively. All the patients were assessed by neuropsycho- logical scales [（Montreal cognitive assessment （MoCA） and Loewenstein occupational therapy cognitive assess- ment（LOTCA）] before treatment. The neuropsychological assessments were executed 1, 2 or 3 months after treatment respectively. Result： （1）The comparison in two groups： MoCA[（13.4±6.8）vs（19.5±5）, （17.1±5.9）vs（26.8±2.9）] and LOTCA [（57.7±10.4）vs（67.1±13）, （68.8±10.2）vs（84.3±2.7）]score improved significantly after treatment in two groups.There were positive relationship between score increase and treatment time. （2）The LOTCA score in experimen- tal group was significantly higher than that in control group after 1 or 3 months treatment （P〈0.05）.but the changes of MOCA score in two groups after 1 or 3 months treatment was not significant（P〉0.05）.（3） The com- parison between the two groups in subtests of MOCA and LOTCA scores： four subtests of visual motion, visu- al spatial and executive ability, attention and memory were significantly higher in experimental group than those in control group. The control group and experimental group had improvement significantly in orientation, perception, visual motion, thinking operation, visual spatial and executive ability and attention after treatment. The memory of control group improved also after treatment, but with no statistical significance. Conclusion： GHD might exist in patients with severe TBI and affect the cognitive function.

关 键 词：颅脑创伤 生长激素 认知功能 康复 

分 类 号：R651.15[医药卫生—外科学] R493[医药卫生—临床医学]