自发性蛛网膜下腔出血患者垂体前叶功能变化研究

目的：探讨自发性蛛网膜下腔出血（ spontaneous subarachnoid hemorrhage ，s-SAH）患者垂体前叶功能减退发生情况、与临床资料的相关性及随访期间恢复情况。方法回顾性分析63例s-SAH发病后7 d、1、2及3年期间垂体前叶分泌情况及与临床资料的相关性。结果30例（47.6％） s-SAH出现垂体功能紊乱。促肾上腺皮质激素（ adrenocorti cotrophic hormone ，ACTH）缺乏最常见9例（14.3％），其次生长激素（growth hormone，GH）分泌不足有8例（12.7％），促性腺激素分泌不足（gonadotropin deficiency ，GnD）有4例（6.3％），甲状腺功能减退（hypothyroidism）2例（3.2％）和高催乳素（prolactin，PRL）1例（1.6％）。6例（9.5％）表现为多激素分泌异常。神经内分泌功能异常的发生率和血管痉挛、Fisher分级和恢复时间有相关性。结论 s-SAH 神经内分泌异常和血管痉挛、Fisher分级和恢复时间有相关性，随访时间应延长。

Follow-up of the serum concentration of pituitary hormones after spontaneous subarachnoid hemorrhage

Objective To explore the risk of pituitary dysfunction for spontaneous subarachnoid hemor -rhage（ s-SAH） patients and to evaluate its correlation with clinical data .Methods 63 cases of patients with s-SAH were selected.Indicators（serum adrenocorti cotrophic hormone （ACTH）, growth hormone（GH）, insulin-like growth factor-1（IGF-1）, thyroid stimulating hormone（TSH）, thyroxine（T4）, triiodothyronine（T3）, follicle-stimulating hormone（FSH）, luteinizing hormone（LH）, total testosterone（in males）, estradiol（in females） and prolactin）dynamic observation were tested 7 days, 1 year, 2 years, 3 years after the onset.Results Thirty patients（ 47.6%） had some type of pituitary dysfunction .ACTH deficiency was the most frequent disorder （14.3%）, followed by GH deficiency（12.7%）, hypogonadatrophic（6.3%）, hypothyroidism（3.2%）and high prolactin（1.6%）.six patients（9.5%）showed deficiencies in more than one axis .Hormone deficiency was related to vasospasm, Fisher grade 4（P〈0.05）and recovery time.Conclusions A greater incidence of hormone deficiency after s-SAH was related with vasospasm , Fisher grade and recovery time .Follow-up time should be extended.