急性颅脑创伤患者垂体功能的改变及其临床意义

目的探讨急性颅脑创伤（TBI）患者垂体功能的改变及其临床意义。方法随机选取急性TBI患者55例作为观察组,15例健康成人作为对照组,采用磁性分离酶联免疫法测定观察组患者伤后第1、3、5、7、14、30 d及对照组第1 d静脉血促肾上腺皮质激素（ACTH）、皮质醇（COR）、三碘甲状腺原氨酸（T3）、四碘甲状腺原氨酸（T4）、促甲状腺素（TSH）、泌乳素（PRL）、卵泡刺激素（FSH）和黄体生成素（LH）水平。分别采用格拉斯哥昏迷评分（GCS）和格拉斯哥预后评分（GOS）评估伤情及预后,对激素水平的变化与伤情严重程度及预后的关系进行统计分析。结果 （1）与对照组相比,观察组血清ACTH、COR均增高,其中中型组及预后好组TBI患者增高更明显,其高峰分别出现于第1和7 d;轻、中、重型组三组间以及预后良好与恶劣两组间的组间比较差异有统计学意义（P〈0.05或0.01）。（2）与对照组相比,观察组血清T3和TSH均明显降低,损伤越重、预后越差者下降越明显,其恢复速度越慢,两组间组间比较差异有统计学意义（P〈0.05或0.01）。（3）各组血清FSH、LH于伤后第1 d均明显升高（P〈0.01）,3 d后恢复正常。（4）各组间血清T4、PRL差异无统计学意义（P〉0.05）。结论 TBI患者急性期垂体前叶激素水平动态变化可作为伤情评价和预后判断的重要指标。

Pituitary dysfunction and its clinical significance in the patients after acute traumatic brain injury

Objective To study the functional change of pituitary and its clinical significance in the patients after acute traumatic brain injury（TBI）.Methods Fifty five patients with acute TBI were randomly chosen as the observation group and 15 health patients were chosen as the control group,and pituitary hormones of adrenocorticotropic hormone（ACTH）,cortisol（COR）,triiodothyronine（T3）,thyro-xine（T4）,thyroid-stimulating hormone（TSH）,prolactin（PRL）,follicle-stimulating hormone（FSH） and luteinizing hormone（LH） were tested at the 1st,3rd,5th,7th,14th and 30th day for the observation group and the 1 day for the control group with magnetic separation ELISA.The degrees of TBI and prognosis were assessed by GCS and GOS.The relationship between the pituitary hormones levels and the severity of TBI as well as prognosis were statistically analyzed.Results（1） When compared to the control group,the levels of ACTH and COR in the observation group were increased significantly higher,and the hormones levels raised as the severity increased and the good prognosis grew,the peaks appeared in the first and the seventh day.The difference among the mild,medium,serve group as well as the good prognosis and bad prognosis group were significant（P0.05 or 0.01）.（2） Both the T3 and TSH levels in TBI patients were significantly lower when compared to the control group,the difference was significant（P0.05 or 0.01）.The more of the hormones levels reduced,the more serious and worse prognosis were,and much slower patients recovered.（3） The FSH and LH levels were significantly increased at the first day after TBI（P0.01）,and normalized three days later.（4） The level of the FSH and LH was no significant（P0.05）.Conclusion The basal volume and dynamic changes of pituitary hormones in TBI patients can serve as a guideline for judging the injury degree and prognosis.