合并多器官功能衰竭的急性脑血管病患者神经内分泌的改变

本实验动态测定了急性脑血管病（ＡＣＶＤ）并发多器官功能衰竭（ＭＯＦ）患者血清生长激素（ＧＨ）、泌乳素（ＰＲＬ）、促黄体生长素（ＬＨ）、促滤泡成熟激素（ＦＳＨ）、睾酮（Ｔ）、孕酮（Ｐ）、雌二醇（Ｅ２）、皮质醇（Ｆ）和血浆促肾上腺皮质激素（ＡＣＴＨ）水平的变化，并与ＡＣＶＤ各疾病组对比。结果发现：ＧＨ、ＰＲＬ、ＡＣＴＨ、Ｆ及ＦＳＨ水平显著升高；ＡＣＶＤ并发ＭＯＦ重型患者（ＭＯＦ积分＞４分）ＰＲＬ、ＧＨ、Ｆ水平显著高于轻型患者（ＭＯＦ积分≤４分）。结果提示ＰＲＬ、ＧＨ和Ｆ可能参与了ＡＣＶＤ并ＭＯＦ的病理生理过程     

电抽搐治疗精神分裂症时血清催乳素和生长激素水平的改变

使用放射免疫分析法对２３例精神分裂症患者在第１、４、６次电抽搐治疗（ＥＣＴ）前、后各１５分钟的血清催乳素（ＰＲＬ）和生长激素（ＧＨ）水平进行了比较研究。结果显示：ＥＣＴ后ＰＲＬ和ＧＨ水平较ＥＣＴ前显著升高，女性患者ＥＣＴ后ＰＲＬ释放值较男性为高，各次ＥＣＴ后ＰＲＬ和ＧＨ的释放值无显著区别；这些提示ＥＣＴ具有神经阻滞剂样抗多巴胺能作用，导致这两种激素水平短暂的升高。     

老年急性脑血管病并多器官功能衰竭患者SIL-2R和T细胞亚群的测定

采用ＥＬＩＳＡ和ＡＰＡＡＰ法对３２例老年急性脑血管病（ＡＣＶＤ）并多器官功能衰竭（ＭＯＦ）患者及４０例老年和３５例非老年ＡＣＶＤ患者血清可溶性白细胞介素２受体（ＳＩＬ２Ｒ）及Ｔ细胞亚群水平进行了测定。并与３０例对照组比较。结果显示，疾病各组除ＣＤ３外ＳＩＬ２Ｒ和ＣＤ８均较对照组明显升高，ＣＤ４／ＣＤ８比值则明显下降，其中以老年ＡＣＶＤ并ＭＯＦ组变化最为显著，与老年和非老年ＡＣＶＤ组比较，亦有显著性差异；ＣＤ４水平老年ＡＣＶＤ并ＭＯＦ组较老年和非老年ＡＣＶＤ组及对照组明显降低，老年和非老年ＡＣＶＤ组与对照组比较无显著性差异；上述指标也与老年ＡＣＶＤ并ＭＯＦ患者的预后密切相关     

老年急性脑血管病并多器官功能衰竭患者SIL—2R和T细胞亚…

采用ＥＬＩＳＡ和ＡＰＡＡＰ法对３２例老年急性脑血管病（ＡＣＶＤ）并多器官功能衰竭（ＭＯＦ）患者及４０例老年和３５例非老年ＡＣＶＤ患者血清可溶性白细胞介素２受体（ＳＩＬ－２Ｒ）及Ｔ细胞亚群水平进行了测定。并与３０例对照组比较。结果显示，疾病各组队ＣＤ３外ＳＩＬ－２Ｒ和ＣＤ８均较对照组明显升高ＣＤ４／ＣＤ８比值则明显下降，其中以老年ＡＣＶＤ并ＭＯＦ组变化最为显著，与老年和非老年ＡＣＶＤ组比较，亦有显著     

脑血管病患者胃动素的临床研究

目的：观察脑出血（ＣＨ）、脑梗死（ＣＩ）、蛛网膜下腔出血（ＳＡＨ）患者胃动素（ＭＴＬ）水平的动态变化及其临床意义。方法：选择脑血管病（ＣＶＤ）患者１３８例。用放免法检测血浆ＭＴＬ浓度。结果：ＣＶＤ各组ＭＴＬ水平显著高于对照组,发病２４ｈ内即升高;ＣＩ组、ＳＡＨ组４～７ｄ达峰水平,ＣＨ组１～３ｄ达峰水平,８～１５ｄ降低,１５ｄ仍在较高水平;随病情严重程度的加重ＭＴＬ水平升高;高血糖组显著高于正常血糖     

急性脑血管病并／不并多器官功能衰竭患者下丘脑──垂体──性腺轴功能研究

为探讨急性脑血管病（ＡＣＶＤ）并发多器官功能衰竭（ＭＯＦ）的机制，研究了１６７例ＡＣＶＤ患者与６１例健康老年人的下丘脑──垂体──性腺轴功能。结果显示：（１）ＡＣＶＤ时出现下丘脑──垂体──性腺轴功能紊乱。（２）单纯ＡＣＶＤ时，性腺轴功能紊乱是暂时的，１周内变化最著，２周后逐渐恢复正常。（３）如性腺轴功能紊乱持续加重，势必导致ＭＯＦ。     

遗传性运动感觉性神经病合并肥厚性心肌病的3D—TCD,rCBF,BAEP…

目的了解遗传性运动感觉性神经病（ＨＭＳＮ）合并肥厚心肌病（ＨＣＭ）的经颅多普勒（ＴＣＤ）局部脑血流量（ｃＣＢＦ），脑干听觉诱发电位（ＢＡＥＰ）和心电图（ＥＣＧ）的变化。方法，对一家三代ＨＭＳＮ合并ＨＣＭ１２例患者和１例无症状者常规进行了这四项检查，结果ＴＣＤ，ｒＣＢＦ，ＢＡＥＰ和ＥＣＧ的异常率分别为８５％，７６％，９２％和９２％。结论绝大多烽ＨＭＳＮ合并ＨＣＭ患者的ＴＣＤ，ｒＣＢＦ，ＢＡＥＰ和ＥＣ     

电抽搐治疗精神分裂症时血清催乳素和生互激素水平的改变

使用放射免疫分析法对２３例精神分裂症患者在第１，４，６次电抽搐治疗前，后各１５分钟的血清催乳素和生长激素水平进行了比较研究。结果显示：ＥＣＴ后ＰＲＬ和ＧＨ水平较ＥＣＴ前显著升高，女性患者ＥＣＴ后ＰＲＬ释放值较男性为高，各次ＥＣＴ后ＰＲＬ和ＧＨ的释放值无显著区别；这些提示ＥＣＴ具有神经阻滞剂样抗多巴胺能作用，导致这两种激素水平短暂的升高。     

蛛网膜下腔出血患者及脑脊液中D—二聚体的动态观察

目的 探讨蛛网膜下腔出血（ＳＡＨ）后血及脑脊液（ＣＳＦ）中纤溶活性的变化规律。方法 应用酶联免疫吸附试验（ＥＬＩＳＡ）双抗体夹心法检测ＳＡＨ患者发病后０～３天（急性期）、４～９天（再出血高峰期）及１４～２１天（吸收期）血及ＣＳＦ中Ｄ－二聚体（Ｄ－Ｄ）含量,并与正常组对照比较。结果 ＳＡＨ后血及ＣＳＦ中Ｄ－Ｄ水平显著增高,但随时间延长而显著降低,０～３天及４～９天显著高于对照组,１４～２１天与对照组     

脑血管疾病急性期血浆ProAdM153—185含量变化及其意义

建立放射免疫分析方法，对出血性（ＨＣＶＤ，ｎ＝１０），缺血性（ＩＣＶＤ，ｎ＝３１）脑血管病急性期患者，以及健康对照者（ｎ＝１０）的血浆肾上腺髓质素前体（ＰｒｏＡｄＭ１５３－１８５）含量进行了研究发现，ＨＣＶＤ组血浆ＰｒｏＡｄＭ１５３－１８５含量显著高于对照组及ＩＣＶＤ组（分别Ｐ＜０．０５及＜０．０１），ＩＣＶＤ组与对照组之间则无显著差异（Ｐ＞０．０５）。在ＩＣＶＤ组中，大灶皮层梗塞患者血浆ＰｒｏＡｄＭ１５３－１８５含量又显著高于皮层下梗塞患者（Ｐ＜０．０１），发病后第３ｄ的患者血浆ＰｒｏＡｄＭ１５３－１８５含量显著高于第１ｄ及第２ｄ的患者（分别Ｐ＜０．０５，０．０１）。提示ＰｒｏＡｄＭ１５３－１８５在脑血管疾病的病理过程中具有作用。     

急性脑血管病患者下丘脑—垂体—肾上腺皮质轴与性腺轴功能研究

急性脑血管病(ACVD)患者的PRL、GH、ACTH、LH、FSH及F水平均显著高于对照组;ACVD并发多器官功能衰竭(MOF)患者,除LH外,余5种激素水平显著高于ACVD各疾病组;随ACVD病程不同,9种激素水平也相应改变,1周时水平最高,2周后逐渐恢复;ACVD并发MOF重型患者(MOF积分>4分)PRL、GH、F水平显著高于轻型患者(MOF积分≤4分)。结果提示PRL、GH和F可能参与ACVD并发MOF的病理生理过程。     

Parental divorce and neuroendocrine changes in adolescents

Plasma noradrenaline (NE), adrenocorticotrophic hormone (ACTH), growth hormone (GH), prolactin (PRL) and luteinizing hormone (LH) concentrations were examined in basal conditions and after stimulation by the step test in two groups of psychophysically healthy adolescent girls, 18 from divorced families and 16 from non-divorced families. Basal NE, ACTH, GH, PRL values did not differ in the two groups, whereas those of LH were significantly lower in the adolescents from divorced parents than in those from non-divorced families. Responses of NE and ACTH to the stimulus were normal, of GH and PRL were weaker, and of LH slightly weaker in children of divorced parents. An impaired catecholaminergic and serotoninergic tonus in children of disrupted families might underly the hormonal alterations.     

Sex-linked differences in cortisol, ACTH and prolactin responses to 5-hydroxy-tryptophan in healthy controls and minor and major depressed patients

Some researchers have found that the administration of 5-hydroxytryptophan (5-HTP) results in increased cortisol secretion in major depressives but not in healthy controls. Other authors observed gender-related differences in cortisol responses to 5-HTP in major depressives. In order to investigate the pituitary/adrenal responsivity to 5-HTP, the authors measured cortisol, adrenocorticotropic hormone (ACTH) and prolactin (PRL) in 30 healthy controls and in 90 depressed patients; the hormone levels were determined in baseline conditions and 60, 90 and 120 min after 125 mg L-5-HTP (orally, non-enteric coated). We found that healthy men had significantly higher cortisol responses to L-5-HTP than healthy women. In the major depressives with melancholia and/or psychotic features these differences were reversed: women exhibited significantly higher cortisol and PRL responses than men. In the female group the most severely depressed patients had increased cortisol and PRL responses to L-5-HTP. The amplitudes of the cortisol, ACTH and PRL responses to L-5-HTP were significantly and positively correlated. It was concluded that the central serotonergic regulation of ACTH and PRL is significantly different between the sexes and between healthy controls, minor depressives and severely depressed patients.     

Effects of long-term antiepileptic therapy on the hypothalamic-pituitary axis in man

Effects of long-term antiepileptic therapy on the hypothalamic-pituitary axis were evaluated from the basal and stimulated plasma levels of growth hormone (GH) and prolactin (PRL) and from circadian adrenocorticotropic hormone (ACTH)/cortisol rhythms. Data for patients with well-controlled epilepsy of mild-to-moderate severity were compared with those for normal healthy volunteers. Analysis of the effects of each antiepileptic drug (AED) and of combined AEDs revealed minor abnormalities of stimulated GH secretion in all treated patients. In epileptic men, all individual AEDs (except valproate) and AED polytherapy increased both basal and stimulated plasma levels of PRL. In epileptic women, this effect was more variable and less marked, probably because of early depletion of PRL reserves. Each AED and combined AEDs did not significantly change circadian ACTH/cortisol rhythms in epileptic patients. The effects observed seem not to be related to epilepsy per se. Clinical implications, pathways, and neurotransmitters involved and possible mechanisms of the neuroendocrine effects of long-term AED therapy are discussed.     

电抽搐治疗引发精神分裂症患者血清催乳素和生长激素水平的改变

目的 探讨电抽搐治疗（ECT）精神分裂症时血清催乳素（PRL）,生长激素（GH）水平的变化情况。方法 采用放射免疫法对21例精神分裂症患者在第1、4、6次ECT前后各15分种的血清PRL、GH水平进行比较研究。结果 ECT和PRL和GH水平较ECT前显著升高;各次ECT后PRL和GH的释放值无显著区别。结论 支持精神分裂症的多巴胺功能亢进的假说,ECT具有神经阻滞样抗多巴胺能作用,导致这两种激素水平一过性升高。     

Neuroendocrine studies in dementia patients: responses of plasma GH and PRL following bromocriptine administration

Bromocriptine stimulates growth hormone (GH) secretion at the hypothalamus and suppresses prolactin (PRL) secretion at the pituitary level. We administered bromocriptine to 30 patients with dementia of the Alzheimer type (DAT), 30 patients with multi-infarct dementia (MID) and 22 age matched healthy controls, and compared response patterns of GH and PRL. Incomplete PRL suppressive responses (suppression rate < 50%) were seen in 36.7% of DAT patients and in 30.0% of MID patients, indicating that both groups had the same degree of pituitary dysfunctions. Blunted GH responses (< 5 ng/ml) were seen in 93.3% of DAT patients, in 63.3% of MID patients and in 31.8% of the controls. The results indicate that neuroendocrine regulation of GH is more selectively and severely damaged in DAT patients than in MID patients at the hypothalamus.     

Neuroendocrine responses to intravenous tryptophan in major depression

The increases in plasma levels of prolactin (PRL) and growth hormone (GH) following intravenous administration of the 5-hydroxytryptamine precursor tryptophan (100 mg/kg) were assessed in 30 depressed patients and 30 control subjects. In depressed patients who lost less than 10 lb, PRL responses were significantly reduced compared with controls. In contrast, the PRL responses of patients with weight loss exceeding 10 lb were significantly greater than those of either controls or the other depressed patients. Growth hormone responses to tryptophan were significantly decreased in patients who lost less than 10 lb. Prolactin, but not GH, responses correlated significantly with the postdexamethasone plasma cortisol concentration; however, an apparent relationship between GH and PRL responses and suicidal behavior was probably due to the common factor of weight loss. The results suggest that depressed patients have different types of abnormal 5-hydroxytryptamine-mediated neuroendocrine responses that correlate with the presence or absence of severe weight loss and cortisol hypersecretion. Further investigations are needed to establish if these abnormalities are central to the depressive disorder or have implications for treatment response.     

Effect of dexamethasone implanted in different brain areas on the morphine-induced PRL, GH and ACTH/corticosterone secretion

We studied the effect of dexamethasone (DEX) implantation in male Wistar rats to elucidate the site of action of morphine-induced prolactin (PRL), growth hormone (GH), adrenocorticotropic hormone (ACTH) and corticosterone (B) secretion. DEX or cholesterol was implanted in the close vicinity of the paraventricular (PVN), or the arcuate nuclei (ARN) of the hypothalamus or into the hippocampus. Five days after implantation blood samples were taken 30 min after i.p. morphine by decapitation or through an indwelling cannula 15, 30, 60 min after i.v. injection. DEX implanted near the PVN resulted in a blockade of morphine-induced ACTH and B secretion. In contrast, GH response to morphine was enhanced, while that of PRL was unchanged. DEX implanted near the ARN significantly inhibited the PRL-releasing effect of morphine, but was without any influence on the PRL secretion induced by haloperidol. There was a partial reduction in the B response to morphine, and GH secretion was unchanged. Dorsal hippocampal implants were without any effect on the morphine-induced GH, PRL or B secretion. We suggest that the site of glucocorticoid inhibitory action in the hypothalamus is the PVN for the opiate-induced ACTH/B secretion, and the ARN for the morphine-induced PRL release. The enhanced GH response to morphine observed in DEX-PVN implanted rats might be due to a decreased somatostatin tone.     

GROWTH HORMONE SECRETION IN PRIMARY DEGENERATIVE DEMENTIA: CORRELATIONS WITH COGNITIVE IMPAIRMENT

Changes in brain peptides and neurotransmitters are thought to elicit alterations of growth hormone (GH) secretion in dementia. Baseline GH levels and hormone responses to GH-releasing hormone (GHRH)—administered alone or after pyridostigmine pretreatment—were evaluated in 17 patients, aged 52–83, with primary degenerative dementia quantified by the Clinical Dementia Rating (CDR) Scale and the Mini-Mental State Examination (MMSE) with a view to detecting correlations between neuroendocrine and clinical data. Basal GH levels were not statistically different in patients and in age-matched controls. However, when patients were split into the three CDR groups of disease severity, basal GH levels were significantly higher in those with more severe dementia than in all other patients and in controls. GH responses to GHRH, evaluated both in terms of peaks attained after simulation and of secretion areas under the curve (AUC), were significantly higher in patients than in controls after pyridostigmine pretreatment, but not after the infusion of GHRH alone. Patients with mild to moderate dementia had GH peaks after GHRH higher than more severe patients. Pyridostigmine did not potentiate GHRH effects in the more severe cases. The scores on Rey's 15-word test for memory function were directly correlated with GH peaks after GHRH. No correlations were found between GH data, age, body weight, disease duration and scores at other psychometric assessments such as MMSE, Raven's matrices, verbal fluency or WAIS tests.