脑梗死后早期垂体功能减退的临床研究  

Clinical Study on Early Pituitary Dysfunction after Cerebral Infarction

作　　者：李云飞[1] 陈刚[1] 汪银洲[1] 林守华[1] 吴梦倩 李永坤[1] LI Yun-fei;CHEN Gang;WANG Yin-zhou;LIN Shou-hua;WU Meng-qian;LI Yong-kun(Fujian Medical University,Fujian Provincial Hospital(Teaching Hospital),Fuzhou,Fujian Province,350001 China)

机构地区：[1]福建医科大学,福建省立医院(教学医院),福建福州350001

出　　处：《中外医疗》2020年第1期4-7,共4页China & Foreign Medical Treatment

基　　金：福建省科技厅引导性项目(2016Y0016)。

摘　　要：目的观察急性脑梗死后早期神经内分泌状态,并探讨发生垂体功能减退的可能危险因素。方法该研究方便选取2016年1月—2018年8月在该院神经科病房住院发病21 d内缺血性脑卒中患者129例,并采用化学发光免疫法检测垂体功能,包括甲状腺激素、促甲状腺素(TSH)、生长激素(GH)、卵泡刺激素(FSH)、黄体生成素(LH)、泌乳素(PRL)、睾酮、雌二醇、促肾上腺皮质激素(ACTH)、皮质醇。按照入院后早期垂体功能评估结果,分为垂体功能正常组与垂体功能减退组,收集各组患者性别,年龄,高血压,2型糖尿病,脑梗死面积,颈内动脉、大脑前动脉及大脑中动脉各脑血管狭窄程度等指标并进行比较,寻找其危险因素。结果急性期激素减退共37例(28.7%):甲状腺素18例(14.0%)、肾上腺素12例(9.3%)、性激素13例(10.0%)、生长素0例(0.0%)。单因素分析显示性别为急性期发生垂体功能减退的危险因子,多因素分析显示:性别(OR=7.429,95%CI:0.135~0.721,P=0.006)、颈内动脉重度狭窄(OR=4.082,95%CI:1.023~4.508,P=0.043)是脑梗死后早期发生垂体功能减退的预测因素。垂体功能是否减退与脑梗死面积大小及是否出血转化之间差异无统计学意义。结论垂体功能减退是在脑梗死急性期的常见现象。以甲状腺素轴和肾上腺素最常受累;男性,颈内动脉重度狭窄是脑梗死后发生垂体功能减退的独立预测因素。Objective To observe the early neuroendocrine status after acute cerebral infarction and to explore the possible risk factors for pituitary dysfunction.Methods From January 2016 to August 2018,129 patients with ischemic stroke were convenienty selected in the neurological ward of the hospital,chemoluminescence immunoassay was used to detect pituitary function,including thyroid hormone and thyrotropin(TSH),growth hormone(GH),follicle stimulating hormone(FSH),luteinizing hormone(LH),prolactin(PRL),testosterone,estradiol,adrenocorticotropic hormone(ACTH),cortisol.According to the results of early pituitary function assessment after admission,the patients were divided into normal pituitary function group and pituitary hypofunction group.The gender,age,hypertension,type 2 diabetes,cerebral infarction area,internal carotid artery,anterior cerebral artery and brain were collected.The indicators of the degree of cerebral vascular stenosis in the arteries were compared and compared to find the risk factors.Results A total of 37 patients(28.7%)had acute steroid loss:18 cases of thyroxine(14.0%),12 cases of epinephrine(9.3%),13 cases of sex hormones(10.0%),and 0 cases of auxin(0.0%).Univariate analysis showed that gender was a risk factor for pituitary dysfunction in the acute phase.Multivariate analysis showed gender(OR=7.429,95%CI:0.135-0.721,P=0.006)and severe internal carotid artery stenosis(OR=4.082,95%CI:1.023-4.508,P=0.043)was a predictor of pituitary dysfunction early after cerebral infarction.There was no statistically significant difference in whether pituitary function decreased and the size of cerebral infarction and whether or not hemorrhage was converted.Conclusion Pituitary dysfunction is a common phenomenon in the acute phase of cerebral infarction.The thyroxine axis and adrenaline are most commonly involved;male,severe internal carotid artery stenosis is an independent predictor of pituitary dysfunction after cerebral infarction.

关 键 词：脑梗死 垂体功能减退 临床研究 

分 类 号：R743.33[医药卫生—神经病学与精神病学]