急性一氧化碳中毒后迟发性脑病患者血清促肾上腺皮质激素释放激素水平及其临床意义

目的探讨急性一氧化碳中毒后迟发性脑病(DEACMP)患者血清促肾上腺皮质激素释放激素(CRH)水平的变化及其临床意义。方法应用酶联免疫吸附法动态测定33例DEACMP患者血清CRH水平,并与32例急性一氧化碳中毒(ACMP)后未发生DEACMP患者和32例正常对照者进行比较;采用日常生活能力量表(ADL)、常识-记忆-注意测验(IMCT)、长谷川痴呆量表(HDS)动态检查DEACMP患者的病情变化。结果 DEAC-MP组急性期血清CRH水平明显高于正常对照组(P<0.05),与ACMP组急性期比较无显著差异(P>0.05);AC-MP组急性期明显高于正常对照组(P<0.05)。DEACMP组恢复期血清CRH水平明显低于急性期(P<0.05),但仍明显高于ACMP组随访期和正常对照组(均P<0.05);ACMP组随访期血清CRH水平明显低于急性期(P<0.05),与正常对照组比较无显著差异(P>0.05)。DEACMP组急性期ADL、HDS、IMCT评分与恢复期比较均有显著差异(均P<0.05)。DEACMP组急性期、恢复期患者血清CRH水平变化与HDS评分变化之间呈显著正相关性(P<0.05)。结论下丘脑-垂体-肾上腺皮质轴参与了DEACMP的发病机制,CRH的水平变化与病情变化基本一致。

Clinical significance of serum corticotropin releasing hormone level in patients with delayed encephalopathy after acute carbon monoxide poisoning

Objective To investigate the serum corticotropin releasing hormone(CRH)level in patients with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP)and its clinical significance.Methods By using ELISA method,the dynamic change of serum CRH level in 33 patients with DEACMP were determined,in comparison with those in 32 acute-carbon-monoxide-poisoning patients without DEACMP and 32 normal controls,respectively.The condition changes were analyzed with three types of scales:the activity of daily living scale(ADL),information-memory–concentration test(IMCT)and Hasegawa’s dementia scale(HDS).Results The serum CRH level in DEACMP group at acute stage was significantly higher than that in controls(P<0.05),but was not significantly different from that in acute carbon monoxide poisoning(ACMP)group at acute stage(P>0.05).The serum CRH level in ACMP group at acute stage was significantly higher than that in controls(P<0.05).The serum CRH level in DEACMP group at convalescent stage was significantly lower than that at acute stage(P<0.05),but still higher than those in ACMP group during follow-up stage and controls(P All valuse<0.05).The serum CRH level in ACMP group during follow-up stage was significantly lower than that at acute stage(P<0.05),and was not significantly different from that in controls(P>0.05).The ADL,HDS and IMCT scores in DEACMP group at acute stage were significantly different from those at convalescent stage(P All valuse<0.05).The serum CRH level in DEACMP group at both acute and convalescent stages was positively correlated to HDS score s(P<0.05).Conclusion Hypothalamus-pituitary-adrenal axis was involved in the pathogenesis of DEACMP and the CRH level variation was basically consistent with the condition change.