中重型颅脑损伤术后早期血清垂体激素水平与预后的关系  

Relationship between the early postoperative serum levels of pituitary hormones and the prognosis of patients with moderate and severe traumatic brain injury

作　　者：段海锋 黄可丰 李敏 崔杰 张浩 乔凯鹏 田志华 DUAN Hai-feng;HUANG Ke-feng;LI Min;CUI Jie;ZHANG Hao;QIAO Kai-peng;TIAN Zhi-hua(Department of Neurosurgery,Jincheng People's Hospital,Shanxi 048000,China)

机构地区：[1]晋城市人民医院神经外科,山西048000

出　　处：《中国临床神经外科杂志》2024年第10期581-585,共5页Chinese Journal of Clinical Neurosurgery

基　　金：山西省卫生计生委科研课题(2019151)。

摘　　要：目的探讨中重型颅脑损伤(TBI)术后早期血清垂体激素水平与病人预后的关系。方法2019年12月至2022年12月前瞻性收治58例中重型TBI,术前及术后1、7、14 d取外周静脉血检测血清垂体前叶激素水平;伤后3个月,采用GOS评估预后,其中4~5分为预后良好,1~3分为预后不良。另选15例健康体检者为对照组。结果与对照组相比,TBI术前血清促肾上腺皮质激素(ACTH)、皮质醇(COR)水平明显增高(P<0.01),血清促甲状腺激素(TSH)水平明显降低(P<0.01),而血清游离三碘甲状腺原氨酸(FT3)、睾酮无明显变化(P>0.05)。TBI术后血清ACTH、COR水平逐渐降低(P<0.01),而血清TSH、FT3、睾酮水平先降低后升高(P<0.05)。伤后3个月,预后良好36例,预后不良22例。相关性分析显示,术前血清ACTH水平(r=-0.532,P<0.001)、术后1 d血清COR水平与伤后3个月GOS评分呈明显负相关(r=-0.277;P=0.035),术后7 d血清睾酮水平(r=0.290;P=0.027)、血清FT3水平(r=0.425;P=0.001)、血清TSH水平(r=0.567;P<0.001)及术后14 d血清睾酮水平(r=0.336;P=0.010)与伤后3个月GOS评分呈明显正相关。结论中重型TBI伤后早期血清ACTH、COR明显升高,后逐渐回落;血清TSH、FT3、睾酮明显下降,后逐渐回升。血清ACTH、COR水平与术后3个月预后呈负相关,而血清FT3、TSH、睾酮水平与术后3个月预后呈正相关。这提示中重型TBI术后早期血清ACTH、COR、FT3、TSH、睾酮水平与病人预后存在一定的关系,可作为判断及评估病人预后的指标,可为及时补充激素提供参考。Objective To investigate the relationship between the early postoperative serum pituitary hormone levels and the prognosis of patients with moderate and severe traumatic brain injury(TBI).Methods From December 2019 to December 2022,58 patients with moderate and severe TBI were prospectively collected.Peripheral venous blood was collected before surgery and on the 1st,7th,and 14th days after surgery to measure the levels of serum pituitary hormones.Three months after the injury,the prognosis was evaluated using the GOS score,with scores of 4~5 indicating a good prognosis and 1~3 indicating a poor prognosis.Another 15 healthy individuals undergoing physical examinations were selected as the control group.Results Compared with the control group,the preoperative serum levels of adrenocorticotropic hormone(ACTH)and cortisol(COR)in TBI patients significantly increased(P<0.01),while the serum level of thyroid stimulating hormone(TSH)significantly decreased(P<0.01),and there were no significant changes in the serum levels of free triiodothyronine(FT3)and testosterone(P>0.05).After surgery,the serum levels of ACTH and COR gradually decreased(P<0.01),while the serum levels of TSH,FT3,and testosterone first decreased and then increased(P<0.05).Three months after injury,36 patients had a good prognosis and 22 patients had a poor prognosis.Correlation analysis revealed that the preoperative serum level of ACTH(r=-0.532,P<0.001),and the serum level of COR on the 1st day after surgery(r=-0.277;P=0.035)were significantly negatively correlated with the GOS score at 3 months after injury,the serum level of testosterone(r=0.290;P=0.027),the serum level of FT3(r=0.425;P=0.001),and the serum level of TSH(r=0.567;P<0.001)on the 7th day after surgery,and the serum level of testosterone on the 14th day after surgery(r=0.336;P=0.010)were significantly positively correlated with the GOS score at 3 months after injury.Conclusions In the early stage after moderate and severe TBI,the serum levels of ACTH and COR increase significantly and th

关 键 词：中重型颅脑损伤 垂体前叶激素 术后早期 血清 预后 

分 类 号：R651.15[医药卫生—外科学]