动脉瘤性蛛网膜下腔出血患者垂体前叶激素水平及临床意义分析  

Levels and clinical significance of anterior pituitary hormones in patients with aneurysmal subarachnoid hemorrhage

作　　者：曲鑫 赵浩 王宁[1] 尚峰 程玮涛[1] 齐猛[1] 徐跃峤[1] 蒋丽丹[1] 陈文劲[1] Qu Xin;Zhao Hao;Wang Ning;Shang Feng;Cheng Weitao;Qi Meng;Xu Yueqiao;Jiang Lidan;Chen Wenjin(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国脑血管病杂志》2020年第7期379-383,402,共6页Chinese Journal of Cerebrovascular Diseases

基　　金：国家自然科学基金(81372473);国家重点研发计划项目(2017YFC1104704)。

摘　　要：目的探讨动脉瘤性蛛网膜下腔出血(a SAH)患者血清促甲状腺激素(TSH)、促肾上腺皮质激素(ACTH)、泌乳素、黄体生成素(LH)、卵泡刺激素(FSH)及生长激素(GH)的水平及临床意义。方法回顾性分析2017年1至12月首都医科大学宣武医院神经外科重症监护室收治的a SAH患者的临床资料,对患者发病后1~3 d血清ACTH、TSH、泌乳素、FSH、LH、GH的数据进行收集,并同时采用经颅多普勒超声检测大脑中动脉血流速度,依据垂体前叶激素水平将患者分为垂体激素分泌异常组(PD组,32例)和垂体激素分泌正常组(PN,59例),并对患者进行6个月随访,采用改良Rankin量表(mRS)评分评估患者预后。结果共纳入91例aSAH患者,男52例,女39例;年龄29~65岁,平均(52±9)岁。PD组血管痉挛发生率、Hunt-Hess分级≥Ⅳ级及Fisher分级≥Ⅲ级患者比例高于PN组[分别为56.2%(18/32)比28.8%(17/59),40.6%(13/32)比16.9%(10/59),56.2%(18/32)比22.0%(13/59)],差异均有统计学意义(χ^2值分别为6.598、6.158、10.814,均P<0.05);PD组56.2%(18/32)患者责任动脉瘤位于大脑前动脉及前交通动脉,较PN组动脉瘤部位分布差异有统计学意义(χ^2值为6.598,P<0.05);PD组ACTH、TSH明显低于PN组[10.26(5.79,32.22)ng/L比28.20(13.78,33.57)ng/L,0.92(0.54,2.27)mU/L比2.32(0.79,3.12)mU/L],差异均有统计学意义(Z值分别为-3.557、-2.154,均P<0.05);PD组预后不良率(31.0%,9/29)高于PN组(9.6%,5/52;χ^2=5.974,P<0.05)。结论a SAH患者垂体前叶激素分泌异常与Fisher分级、Hunt-Hess分级、动脉瘤部位、脑血管痉挛及预后有关。Objective To investigate the changes of serum thyroid-stimulating hormone(TSH),adrenocorticotropic hormone(ACTH),prolactin,luteinizing hormone(LH),follicle stimulating hormone(FSH)and growth hormone(GH)in patients with aneurysmal subarachnoid hemorrhage(a SAH)and the clinical significance.Methods The clinical data of patients with a SAH admitted to the Department of Neurosurgical Intensive Care Unit at Xuanwu Hospital of Capital Medical University from January 2017 to December 2017 were analyzed retrospectively.The level of serum ACTH,TSH,prolactin,FSH,LH,and GH were collected at first to third day after onset.The mean flow velocity of middle cerebral artery blood was detected by transcranial Doppler.The patients were divided into the deficiency group of pituitary hormone secretion(PD group,32 cases)and the normal group of pituitary hormone secretion(PN group,59 cases)according to anterior pituitary hormone levels,and were followed up for 6 months.The assessment of patients’prognosis was according to the modified Rankin score(mRS).Results A total of 91 patients with a SAH were enrolled,including 52 males and 39 females,aged 29-65 years(mean,52±9 years).The incidence of vasospasm(56.2%[18/32]vs.28.8%[17/59]),and the ratio of Hunt-Hess≥Ⅳand Fisher≥Ⅲin PD group(40.6%[13/32]vs.16.9%[10/59],56.2%[18/32]vs.22.0%[13/59],respectively)were higher than those in PN group(χ^2=6.598,6.158,10.814,respectively,all P<0.05).The incidence of aneurysms in the anterior cerebral artery and anterior communicating artery in PD was significantly higher than that in aneurysms elsewhere(χ^2=6.158,P<0.05).The levels of ACTH and TSH in PD group were lower than those in PN group(10.26[5.79,32.22]ng/L vs.28.20[13.78,33.57]ng/L,0.92[0.54,2.27]mU/L vs.2.32[0.79,3.12]mU/L)with significant difference(Z=-3.557,-2.154,respectively,all P<0.05).The rate of poor prognosis in PD group(31.0%,9/29)was higher than that in PN group(9.6%,5/52;χ^2=5.974,P<0.05).Conclusion The abnormal secretion of anterior pituitary hormones in patients with a

关 键 词：动脉瘤性蛛网膜下腔出血 垂体激素 血管痉挛 

分 类 号：R743.35[医药卫生—神经病学与精神病学]