急性脑出血患者24 h不同时点血浆促肾上腺皮质激素和皮质醇变化的临床意义

目的进一步了解急性脑出血患者血浆中促肾上腺皮质激素（ACTH）和皮质醇水平及昼夜节律的变化。探讨其临床意义。方法采用放射免疫法检测40例脑出血和30例对照组24h内8时、16时和24时的血浆ACTH和皮质醇含量，分别与出血量大小和预后进行比较。结果急性脑出血患者血浆ACTH和皮质醇水平显著高于对照组；血浆ACTH和皮质醇水平在3个时，置与出血量大小呈正相关。在出血量大，预后差的患者两种激素水平明显增高，昼夜节律逆转。结论检测血浆ACTH和皮质醇水平，观察昼夜节律，可判断急性脑出血患者的病情和预后，指导临床治疗。

Change of plasma ACTH and cortisol levels at 3 different time in 24 hours on acutecerebral hemorrhages

Objective] The aim of this study was to characterize the response of ACTH and cortisol at 3 different time in 24 hours of acute cerebral hemorrhages.Methods] The levels of 8 am,16 pm and 24 pm plasma ACTH and cortical were measured by means of RIA in 40 patients with cerebral hemorrhages and 30 age-matched as controls.Volume of brain damage and clinical outcome were assessed.Results] Plasma ACTH and cortisol values were significantly increased in acute cerebral hemorrhages.Both ACTH and cortisol levels at 3 different time were related positively to volume of brain damage.Their values were statistical significantly higher in large hemorrhage and unfavorable prognosis than values in moderate and mild hemorrhage groups and favorable prognosis.Both circadian rhythmus of secretion of ACTH and cortisol were reversed in those patients with large hemorrhage and unfavorable prognosis.Conclusion] High activation of ACTH and cortisol and their circadian rhythmus reverse or disturbance were observed in relation to severity and prognosis on acute cerebral hemorrhages.