动脉瘤性蛛网膜下腔出血患者康复期垂体功能不全的临床研究  

Prevalence of chronic hypopituitarism after aneurismal subarachnoid hemorrhage

作　　者：陈茂送[1] 王洪财[1] 王波定[1] 孙成丰[1] 沈罡[1] 陈海[1] 

机构地区：[1]宁波市医疗中心李惠利医院神经外科,315040

出　　处：《浙江医学》2014年第10期854-856,共3页Zhejiang Medical Journal

基　　金：宁波市自然科学基金(2011A610041)

摘　　要：目的观察动脉瘤性蛛网膜下腔出血(aSAH)患者康复期腺垂体激素水平变化,探讨其垂体功能不全发生率及发生类型。方法选取aSAH患者47例.出血后12个月行GOSE评分评估预后,同期应用化学发光免疫分析法检测患者生长激素(GH)、促肾上腺皮质激素(ACTH)、促甲状腺素(TSH)、生殖激素[血清泌乳素(PRL)、促卵泡生成素(FSH)、促黄体生成素(LH)、雌二醇及睾酮]。结果 GOSE评分预后良好32例,预后不良15例(死亡2例)。预后良好的32例患者中腺垂体激素水平异常者13例(40.6%),其中单纯GH、ACTH、TSH及生殖激素水平低下分别为4、1、1、4例,GH合并生殖激素低下2例,GH合并ACTH低下1例;预后不良13例患者中腺垂体激素水平异常者6例(46.2%),其中单纯GH、ACTH及生殖激素水平低下分别为2、1、1例,GH合并生殖激素低下1例,GH合并ACTH低下1例。预后良好患者与不良患者腺垂体激素水平异常发生率的差异无统计学意义(P>0.05)。结论 aSAH患者康复期垂体功能不全发生率较高,以单一激素水平低下为主,表现为疲劳困倦、记忆力下降、抑郁等神经精神症状,但不影响神经功能预后。Objective To investigate the prevalence of hypopituitarism fol owing aneurismal subarachnoid hemorrhage （aSAH） in chronic stage. Methods Prospective cohort study was performed in 47 patients with aSAH. Twelve months after aSAH, the fol ow- up prognosis was evaluated by GOSE score （Glasgow Outcome Scale- Extended score） and testing major an-terior pituitary hormones. Results According to GOSE score, patients were classified into good outcome group （n=32） and poor outcome group （n=15, including 2 deaths）. In good outcome group the hypopiruitarism developed in 13 cases （40.6%）, including GH deficiency （4 cases）, corticotroph deficiency （1）, hypothyroidism （1） and hypogonadism （4）, and GH deficiency with hypogo-nadism （2） or corticotroph deficiency （1）. In poor outcome group abnormal pituitary hormones were detected in 6 patients （46.2%）, including GH deficiency （2 cases）, corticotroph deficiency （1）, and hypogonadism （1）, GH deficiency accompanied by hypogonadism （1） or corticotroph deficiency （1）. There was no significant difference in prevalence of hypopituitarism between two groups （P〉0.05）. Conclusion Results suggest that hypopituitarism occurs frequently in patients with aSAH in chronic stage. Hypopituitarism would not contribute to the neurological outcome, but is associated with cognitive deficits, emotional changes, fatigue, or other neuropsychological sequelae of patients.

关 键 词：动脉瘤 蛛网膜下出血 垂体功能不全 

分 类 号：R743.35[医药卫生—神经病学与精神病学]