垂体前叶激素及甲状腺激素在不同疾病严重程度创伤性颅脑损伤患者中的表达水平及意义

目的　探究与分析垂体前叶激素及甲状腺激素在不同疾病严重程度创伤性颅脑损伤患者中的表达水平及意义。方法　选取晋城市人民医院自2017年5月至2020年5月收治的创伤性颅脑损伤患者103例作为观察组，其中男58例，女45例，年龄（43.12±4.11）岁，合并颅骨骨折5例、脑震荡7例、脑挫伤11例、硬膜外血肿9例、硬膜下血肿8例，伤后入院时间（30.25±4.11）h，对该组人员均采用酶联免疫吸附测定法对发生创伤性颅脑损伤后的第1、7、14、30天的血清催乳素（PRL）、卵泡刺激素（FSH）、促黄体生成素（LH）、促甲状腺激素（TSH）、三碘甲状腺原氨酸（T3）、甲状腺素（T4）水平进行测量。另选择同时期来晋城市人民医院接受常规体检的正常人100例作为对照组，其中男55例，女45例，年龄（43.20±4.34）岁，测量上述相同指标，对两组的垂体前叶激素及甲状腺激素水平进行对比。同时将观察组患者按照格拉斯哥昏迷评分（GCS）分组，分为轻型组（13～14分）、中型组（9～12分）与重型组（3～8分）；将观察组患者按照不同预后分为死亡组、残疾组及良好组；对不同GCS分组、不同预后分组下下丘脑垂体前叶激素及甲状腺激素水平进行对比。计量资料两组间比较采取独立样本t检验，多组间比较采用F检验，计数资料采用χ²检验。结果　观察组颅脑损伤后1 d、7 d分别与对照组相比PRL、FSH、LH、TSH、T4水平均较高，T3水平均较低，观察组于颅脑损伤后7 d开始PRL、FSH、LH、TSH、T4水平逐渐降低，T3水平升高，在颅脑损伤后14 d的PRL、FSH、LH、TSH、T4水平与对照组相比仍较高，T3水平较低，差异均有统计学意义（均P<0.05）。重型组分别与中型组、轻型组相比PRL、FSH、LH、TSH、T4水平较高，T3水平较低，中型组与轻型组相比PRL、FSH、LH、TSH、T4水平较高，T3水平较低，差异均有统计学意义（均P<0.05）。死亡组分别与残疾组、良好组相比PRL、FSH、LH、TSH、T4水平较高，T3水平较低，残疾组与良好组相比PRL、FSH、LH、TSH、T4水平较高，T3水平较低，差异均有统计学意义（均P<0.05）。结论　在发生创伤性颅脑损伤之后垂体前叶激素及甲状腺激素水平均明显升高，且上述指标的变化有利于帮助对创伤性颅脑损伤患者疾病严重程度及预后的判断，同时为临床治疗提供可靠依据。

Expression levels and significance of anterior pituitary hormones and thyroid hormones in patients with traumatic brain injury under different disease severity degrees

Objective　To explore and analyze the expression levels and significance of anterior pituitary hormones and thyroid hormones in patients with traumatic brain injury under different disease severity degrees. Methods　A total of 103 patients with traumatic brain injury treated in Jincheng People's Hospital from May 2017 to May 2020 were selected as an observation group, including 58 males and 45 females, with an age of (43.12±4.11) years old, with 5 cases of skull fractures, 7 cases of cerebral concussion, 11 cases of cerebral contusion, 9 cases of epidural hematoma, and 8 cases of subdural hematoma, with the admission time after injury of (30.25±4.11) h. Serum levels of prolactin (PRL), follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid stimulating hormone (TSH), triiodothyronine (T3), and thyroxine (T4) were measured by enzyme-linked immunosorbent assay (ELISA) on day 1, 7, 14, and 30 after traumatic brain injury. A total of 100 normal people who came to Jincheng People's Hospital for routine physical examination during the same period were selected as the control group, including 55 males and 45 females, with an age of (43.20±4.34) years old, the same indicators mentioned above were measured, and the levels of anterior pituitary hormones and thyroid hormones were compared between the two groups. At the same time, the patients in the observation group were divided into a mild group (13-14 points), a moderate group (9-12 points), and a severe group (3-8 points) according to the Glasgow Coma Scale (GCS) score, and were divided into a death group, a disability group, and a good group according to the prognosis. The levels of anterior pituitary hormones and thyroid hormones in different GCS groups and different prognostic groups were compared. Independent sample t test was used for comparison of the measurement data between two groups, F test was used for comparison among multiple groups, and χ² test was used for the count data. Results　Compared with those in the control group, the levels of PRL, FSH, LH, TSH, and T4 in the observation group were higher on day 1 and 7 after craniocerebral injury, while the level of T3 was lower; the levels of PRL, FSH, LH, TSH, and T4 in the observation group decreased gradually and the level of T3 increased since day 7 after craniocerebral injury; the levels of PRL, FSH, LH, TSH, and T4 were still higher than those of the control group on day 14 after craniocerebral injury, while the level of T3 was lower, with statistically significant differences (all P<0.05). The severe group had higher levels of PRL, FSH, LH, TSH, and T4 and a lower level of T3 compared with the moderate group and the mild group, respectively; the moderate group had higher levels of PRL, FSH, LH, TSH, and T4 and a lower level of T3 compared with the mild group, with statistically significant differences (all P<0.05). The death group had higher levels of PRL, FSH, LH, TSH, and T4 and lower level of T3 compared with the disability group and the good group, respectively; the disability group had higher levels of PRL, FSH, LH, TSH, and T4 and lower level of T3 compared with the good group, with statistically significant differences (all P<0.05). Conclusion　After traumatic brain injury, the levels of anterior pituitary hormones and thyroid hormones are significantly increased, and the changes of above indicators are helpful to judge the disease severity degree and prognosis in patients with traumatic brain injury, and provide reliable basis for clinical treatment.