颅脑创伤后慢性垂体功能低下发病情况及替代治疗研究

目的 探讨颅脑创伤慢性期垂体各型激素低下发病情况及替代治疗的效果。 方法 以120名颅脑创伤慢性后遗症患者作为研究对象，收集患者一般临床资料和CT影像学资料，并于伤后6个月和12个月分别测定患者垂体生长激素(GH)、促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)、促性腺激素(LH/FSH)缺乏和抗利尿激素(ADH)，使用多因素Logistic回归分析颅脑创伤后垂体功能低下的影响因素。另外对垂体功能低下患者行GH替代治疗，评估替代治疗的疗效。 结果 伤后12个月患者GH、ACTH、TSH、LH/FSH和ADH缺乏发病率分别为19.2%、3.3%、0%、12.5%和1.7%，与伤后6个月比，患者GH缺乏发病率无明显改变，而其他激素缺乏均有一定程度恢复。垂体功能低下组BMI、缺氧比例、弥漫性脑肿胀比例、经手术清除的脑内血肿比例和头颅CT总分数均显著高于非垂体功能低下组。多因素Logistic回归分析显示BMI、缺氧、弥漫性脑肿胀和头颅CT总分数是颅脑创伤后垂体功能低下的独立危险因素。进一步行GH替代治疗发现，治疗后垂体功能低下组患者残疾程度评分显著优于治疗前(P＜0.05)。 结论 颅脑创伤后GH和LH/FSH缺乏发生率高且持久，BMI、缺氧、弥漫性脑肿胀和头颅CT总分数是颅脑创伤后垂体功能低下的独立危险因素。GH替代治疗有利于垂体功能低下患者的恢复。 

Chronic hypopituitarism after traumatic brain injury and replacement therapy

Objective To investigate themorbidity of chronic pituitary hormone deficiency and the efficacy of replacement therapy in patients with traumatic brain injury. Methods Total 120 patients with chronic sequelae of cerebral trauma were enrolled and assessed at 6 and 12 months after injury for hormonal function.Major hormonal deficiencies,including GH,ACTH,TSH,LH/FSH and ADH deficiencies,were identified.The clinical data and CT imaging data were analyzed.The general and acute injury characteristics were compared in patients with and without hypopituitarism by the use of multivariate logistic analysis.In addition,GH replacement for hypopituitarism patients was conducted,and the efficacy was assessment. Results Out of 120 patients tested at 12 months after injury,the incidence of GH,ACTH,TSH,LH/FSH and ADH deficiency was 19.2%,3.3%,0%,12.5% and 1.7%,respectively.As compared to 6 months after injury,there was no different for GH deficiency,however,other hormonal deficiencies were a certain degree of recovered.Compared with the non-hypopituitarism patients,hypopituitarism patients had higher BMI,hypoxia rate,diffuse brain swelling,evacuated intracranial hemorrhage rate and computed tomography score(P＜0.05).The multivariate logistic model revealed that BMI,hypoxia rate,diffuse brain swelling,and computed tomography score were independent risk factors for hypopituitarism patients.In addition,compared with the pre-treatment value,hypopituitarism patients had better LCFS,DRS and FIM scores after GH replacement therapy. Conclusions The incidences of GH and LH/FSH deficiency were high for patients after traumatic brain injury;BMI,hypoxia rate,diffuse brain swelling,and computed tomography score were independent risk factors for hypopituitarism patients.GH replacement for hypopituitarism patients was useful for their recovery.