【作者】 胡峰；

【导师】 张赛；

【作者基本信息】 天津医科大学 ， 外科学， 2007， 硕士

【摘要】 背景:创伤性颅脑损伤(traumatic brain injury TBI)已经成为威胁公众健康的严重问题。近年来研究发现,TBI后垂体前叶激素异常的发生率并不低,垂体机能异常减退可能导致或加重TBI造成的患者躯体、认知、心理方面的损伤并影响康复治疗,如及时发现垂体前叶激素异常及其变化规律并采取有效治疗措施,有可能提高对伤情评估和预后判断的准确性,并改善TBI患者的预后。目的:通过测定重型TBI(sTBI)患者伤后不同时间点血清中生长激素(GH),促甲状腺激素(TSH),卵泡刺激素(FSH),黄体生成素(LH)和泌乳素(PRL)的含量,初步探讨垂体前叶激素异常的发生率、变化规律以及与伤情和预后之间的关系。为临床诊断外伤后垂体前叶激素异常和采用激素替代疗法改善患者预后提供更多的研究数据。方法:随机选取2006年1月～2006年12月间急性sTBI住院患者48例作为脑创伤组,再按入院时GCS的不同划分为重型组和特重型组。于伤后第1,7,14,21天分别抽取患者静脉血3ml,分离血清,采用化学发光法测定垂体前叶激素含量。另随机选取20例健康志愿者作为对照组,取静脉血一次进行测定。以上各组年龄、性别均无明显差异。脑创伤组患者在伤后3个月时,根据病历记录或随访结果,按GOS评分标准分为预后不良组(GOS≤3)和预后良好组(GOS＞3)。结果:(1)伤后FSH和LH异常的发生率可高达到52.1%和45.8%。(2)重型组及特重型组伤后第1天GH和TSH水平与对照组比较具有统计学意义(P＜0.05)。重型组及特重型组伤后第1、7、14、21天FSH和LH水平与对照组比较具有统计学意义(P＜0.05)。重型组与特重型组比较不具有统计学意义(P＞0.05)。(3)预后不良组患者伤后第1天TSH水平与预后良好组比较具有统计学意义(P＜0.05),随后的3次测定与预后良好组比较也具有统计学意义(P＜0.05)。预后不良组患者伤后第1、7、14、21天的FSH和LH水平与预后良好组比较具有统计学意义(P＜0.05)。预后不良组伤后第1天GH和PRL水平与预后良好组比较具有统计学意义(P＜0.05)。结论:(1)sTBI后FSH和LH变化发生最为常见。(2)伤后垂体前叶激素可发生明显变化,重型组及特重型组伤后第1天GH和TSH高于对照组,重型组及特重型组伤后第1、7、14、21天的FSH和LH水平低于对照组,随着伤后病情好转及时间的推移垂体分泌功能呈现不同程度恢复。急性sTBI患者伤后垂体前叶激素的变化程度与伤情的没有明显的联系。(3)sTBI患者伤后垂体激素的动态变化对于判断预后有重要参考价值,凡是伤后第1天出现垂体前叶激素水平明显高于或低于正常值,随后呈持续低水平者,提示预后不良;伤后第1天垂体前叶激素水平变化明显但能够很快恢复以及伤后激素水平变化不大者,提示预后良好。更多还原

【Abstract】 Background: Traumatic brain injury (TBI) has already became the serious problem threaten public health. In recent studies, the change of Anterior pituitary hormone is not rare after TBI, the pituitary function abnormality may exacerbate existing impairments of physical, cognitive caused by TBI, if Anterior pituitary hormone abnormality can be diagnosed timely and the rules of dynamic change can be found, we can evaluate the outcome more properly and improved the outcome.Objective: By measure the levels of the GH, TSH, FSH, LH and PRL on the patients suffered sTBI in different times after hospitalized. To stude the rule of the dynamic changes and to investigate the relationship between pituitary function abnormality and the outcome. So we can know more about the clinical diagnosis and the hormone substitution therapy to improve the outcome.Methods: From January, 2006 to December, 2006, 48 cases of the hospitalized patients with acute sTBI were enrolled to be traumatic group and measured the levels of the GH, TSH, FSH, LH and PRL on 1st, 7th, 14th, 21st days after hospitalized . meanwhile, 20 normal control persons were sellected and measured the same hormones. Clinical outcomes were valued by using the Glasgow Outcome Scale score(GOSs) at 3 months after injury.Results: (1) The incidences of abnormality about FSH and LH can reach as high as to 52.1% and 45.8%. (2) On 1st day, Statistics significance (P < 0.05) can be observed when we compare TSH in ssTBI group and sTBI group to normal control group. On 1st, 7th, 14th, 21st days after hospitalized, Statistics significance (P < 0.05) can be observed when we compare FSH and LH levels in ssTBI group and sTBI group to normal control group. There is no statistics significance between ssTBI group and sTBI group. (3) On 1st day after hospitalized, the TSH level in poor outcome group was significantly higher than the one in the favorable outcome group, but on 7th, 14th, 21st days, the level was significantly lower. On 1st, 7th, 14th, 21st days, the FSH and LH levels in poor outcome group was significantly lower than the levels in the favorable outcome group. On 1st day, the GH and PRL levels in poor outcome group was significantly higher than the levels in the favorable outcome group.Conclusion: (1) The change of FSH and LH is the most common with the patients after sTBI. (2) The Anterior pituitary hormone may significantly change after TBI. On the 1st day, TSH level in ssTBI group and sTBI group is higher than the normal control group. On 1st, 7th, 14th, 21st days, FSH and LH levels in ssTBI group and sTBI group lower than the normal control group. When condition of the patients became better, the pituitary function seem can be improved gradually. But there is no significant relationship between the change of the hormones and severity. (3) The change of the change of the anterior pituitary hormone can be use to predicating the outcome of the sTBI. The hormone level of the patients in poor outcome group will significantly change on 1st day after injure or decrease fiercely in follow days. On the contrary, the patient whose hormone level change slightly or can be greatly improved will have favorable outcome.更多还原