动脉瘤性蛛网膜下腔出血后下丘脑-垂体功能减退的研究进展  

Research progress in the hypothalamus-hypopituitarism after aneurysmal subarachnoid hemorrhage

作　　者：江顺婷[1] 何伟文[1] 

机构地区：[1]广州医科大学附属第二医院神经外科,510260

出　　处：《中华脑科疾病与康复杂志（电子版）》2015年第1期50-53,共4页Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

基　　金：广东省科技计划项目(2012B031800238);国家科技支撑计划(2011BAI08B06)

摘　　要：动脉瘤性蛛网膜下腔出血平均发病率为9/10万人年,平均死亡率50%,平均发病年龄50岁,占脑卒中的5%-10%,因其预后较差,发病年龄相对年轻,对家庭经济的打击、社会劳动力丧失的影响比其他类型的卒中更为显著。经历蛛网膜下腔出血的生还者,尽管神经病学的评估良好（格拉斯哥预后评分4-5分）,但存在躯体和神经心理方面的后遗症,表现为认知功能下降、疲乏、性功能明显下降或丧失、体重下降、抑郁症等脑损伤后综合征,相当一部分患者生活质量不高且不能回到原工作岗位。而对蛛网膜下腔出血生还者出血后数月至1年进行内分泌学评估,结果发现11%-55%的患者存在垂体前叶单轴、多轴或全垂体功能减退。对存在脑垂体功能减退的患者进行适当的激素替代治疗有可能改善部分或大部分脑损伤后综合征的症状及体征,促进患者的恢复,提高生活质量,增强工作能力。Aneurysmal subarachnoid hemorrhage （ aSAH ） accounts for 5% -10% of stroke, which occurs with an average incidence of 9 cases per 100 000 patient years, an average mortality rate of 50% ,and an age mean in the fifth decade. For the age of onset is relatively young, both of the economic impact on family and the loss of labor are more significant than other types of stroke. Patients who have sustained aSAH often suffer persistent impairments in physical and neuropsychological disturbances despite a good neurological outcome（ Glasgow outcome scale score is 4-5 ）, such as cognitive impairment, fatigue, decreased or loss of sexual function, weight loss and depression which are called brain injury syndrome （BIS）. A high percentage of patients have a poor quality of life and cannot be reintegrated into work. The endocrinology evaluation of 11% -55% survivors after SAH in several months to 1 year had shown hypopituitarism, including panhypopituitarism（ PH）, multiple hypopituitarism（MH） and isolated hypopituitarism（IH）. It is reported that proper hormone replacement therapy may improve the quality of life of aSAH patients and even enhance their ability back to work.

关 键 词：颅内动脉瘤 蛛网膜下腔出血 垂体功能减退症 激素替代疗法 脑损伤后综合征 

分 类 号：R743.3[医药卫生—神经病学与精神病学]