慢性意识障碍患者垂体相关激素变化及影响因素分析  

Changes of pituitary hormones and related factors in patients with prolonged disorders of consciousness

作　　者：杨艺 党圆圆 夏小雨 徐珑[1] 陈雪玲 耿小丽 刘伟明[1] 何江弘 YANG Yi;DANG Yuanyuan;XIA Xiaoyu;XU Long;CHEN Xueling;GENG Xiaoli;LIU Weiming;HE Jianghong(Department of Neurosurgery,Beijing Tiantan Hospital Affiliated to Capital Medical University,Beijing,100070;Department of Neurosurgery,the Seventh Medical Center of Chinese PLA General Hospital,Beijing,100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100070 [2]解放军总医院第七医学中心神经外科,北京100700

出　　处：《第三军医大学学报》2021年第15期1430-1436,共7页Journal of Third Military Medical University

基　　金：国家自然科学基金青年科学基金(81600919);北京市科技新星(Z181100006218050)。

摘　　要：目的研究慢性意识障碍(prolonged disorders consciousness, pDOC)患者垂体相关激素水平变化及其与患者预后的相关性,分析激素水平与患者意识预后的高危因素。方法回顾性分析首都医科大学附属北京天坛医院神经外科及解放军总医院第七医学中心神经外科2018年1月至2020年12月收治的87例pDOC患者的临床资料,根据患者意识改善的情况,分为意识恢复组(39例)和意识未恢复组(48例),测定两组患者的垂体相关激素的分泌水平,包括游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、促肾上腺皮质激素(ACTH)、生长激素(GH)、皮质醇(cortisol)、催乳激素(PRL)。根据昏迷恢复量表-修订版(coma recovery scale-revised, CSR-R)评分,将患者分为两个不同意识水平组:植物状态(vegetative state, VS)组(61例)和微意识状态(minimally consciousness state, MCS)组(26例),分析pDOC患者垂体相关激素的变化水平与意识的关系;根据激素水平的正常标准,将患者分为激素水平正常组(25例)与激素水平异常组(62例),采用单因素分析和Logistic回归模型探讨pDOC患者垂体相关激素变化的影响因素[年龄、性别、致伤原因、病程、术前昏迷恢复量表-修订版(CRS-R)评分及受伤部位等]。结果 87例pDOC患者中62例发生垂体激素异常(71.3%);42例发生单项激素异常(67.7%),两项以上改变的有20例(32.3%)。垂体激素异常的类型例数及比例依次为:GH 18例(29.0%)、TSH及FT3/FT4 19例(30.6%)、PRL 11例(17.7%)、ACTH 8例(12.9%)、COR 6例(9.7%)。比较两个不同意识水平(VS组和MCS组)垂体相关激素水平之间的差异,发现两组GH、TSH、PRL、ACTH差异均有统计学意义(P<0.01)。与激素水平正常组相比,激素水平异常组的发病年龄更高(P=0.001),MCS患者所占比例(P=0.001)和CRS-R评分(P<0.001)更低,ICU停留时间更长(P<0.001),而合并阵发性交感神经多度兴奋综合征(paroxysmal sympathetic hyperacObjective To study the changes of pituitary-related hormones in patients with prolonged disorders of consciousness(pDOC)and its influence on the prognosis of patient in order to explore the risk factor of hormone levels with consciousness level and prognosis of patients.Methods The clinical data of 87 pDOC patients admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University and the Department of Neurosurgery of the Seventh Medical Center of Chinese PLA General Hospital from January 2018 to December 2020 were analyzed retrospectively.According to the improvement of patients’consciousness,they were divided into consciousness recovery group(n=39)and consciousness non-recovery group(n=48).The secretion levels of pituitary related hormones were measured in the 2 groups,including free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH),adrenocorticotropic hormone(ACTH),growth hormone(GH)and cortisol and prolactin(PRL).According to Coma Recovery Scale-Revised(CSR-R)score,the patients were assigned into vegetative state VS group(n=61)and minimal consciousness state MCS group(n=26).The relationship between the changes of pituitary hormones and consciousness of pDOC patients was analyzed.According to the normal standard of hormone level,the patients were divided into normal hormone level group(n=25)and abnormal hormone level group(n=62).Univariate analysis and logistic regression model were used to explore the influencing factors(age,sex,cause of injury,course of disease,preoperative CRS-R score and injured location,etc.)of pDOC patients.Results Among the 87 pDOC patients,62(71.3%)had abnormal pituitary hormones,including 42 cases of single hormone abnormality(67.7%),and 20 cases of more than 2 changes(32.3%).The types and proportions of abnormal pituitary hormones were:GH 18 cases(29.0%),TSH and FT3/FT419 cases(30.6%),PRL 11 cases(17.7%),ACTH 8 cases(12.9%),and COR6 cases(9.7%).In the comparison of the differences of pituitary hormone levels betw

关 键 词：慢性意识障碍 垂体相关激素水平 疾病特征 预后 危险因素 

分 类 号：R335.1[医药卫生—人体生理学] R347[医药卫生—基础医学]