摘要
目的分析创伤性脑外伤患者(TBI)急性期垂体功能紊乱的临床特点。方法对158例TBI患者的病史资料进行回顾性分析。所有患者入院后进行Glasgow昏迷等级评分(GCS)和急性生理功能和慢性健康状况(APACHE)Ⅱ评分。24h内采集血样,化学发光法测定与垂体功能相关的激素分泌水平,包括游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、皮质醇、卵泡刺激素(FSH)、黄体生成素(LH)、生长激素(GH)、促肾上腺皮质激素(ACTH)、雌二醇(E2)等。根据临床情况和实验室检测指标对患者急性期垂体功能进行判断。采用直线相关分析及受试者工作特征(ROC)曲线对与TBI患者病情严重程度及死亡的可能相关因素进行统计学分析。结果TBI患者急性期垂体前叶激素异常的LH/FSH、GH、ACTH、TSH缺乏和低T3综合征的发生率分别为29%、27%、8.9%、3.2%和53%;垂体后叶激素异常的尿崩症和抗利尿激素分泌不当综合征发生率分别为1.2%和3.8%。FT3水平与GCS呈明显正相关(r=0.245,P=0.002);ROC曲线显示,APACHEⅡ评分、皮质醇和E2水平对患者死亡的影响有统计学意义(均P(0.01)。结论TBI患者急性期垂体功能明显受损。FT3水平可反映患者的病情严重程度;APACHEⅡ评分、皮质醇和E2水平与TBI引起的死亡明显相关。
Objective To analyse the clinical characteristics of pituitary dysfunction in the acute phase of patients with traumatic brain injury （TBI）. Methods The medical records of 158 patients with TBI were retrospectively analysed. Glasgow coma scale （GCS） and Acute Physiology and Chronic Health Evaluation （APACHE） Ⅱ score were applied after admission. Blood samples were collected within 24 h after admission for the measurement of hormones associated with pituitary function such as free triiodothyronine （FT 3） ,free thyroxine （FT 4）,thyroid-stimulating hormone （TSH）,cortisol,follicle-stimulating hormone （FSH）,luteinizing hormone （LH）,growth hormone （GH）,adrenocorticotropic hormone （ACTH） and estradiol （E 2）. The pituitary function in acute phrase of TBI was evaluated based on the clinical data and laboratory findings. The possible factors related to the severity of TBI and mortality were statistically analysed with linear correlation analysis and receiver operating characteristic （ROC） curve. Results The prevalences of LH/FSH deficiency,GH deficiency,ACTH deficiency,TSH deficiency and low T 3 syndrome were 29%,27%,8.9% ,3.2% and 53%,respectively. Diabetes insipidus was found in 1.2% and syndrome of inappropriate antidiuretic hormone was found in 3.8% of patients. FT 3 was significantly positively related to GCS（r=0.245,P=0.002）.It was revealed by ROC curve that APACHE Ⅱscore,cortisol and E 2 were significantly related to mortality （P﹤0.01）. Conclusion Pituitary function is significantly impaired in the acute phase of TBI. FT 3 is related to the severity of trauma,and APACHEⅡscore,cortisol and E 2 were related to the mortality caused by TBI.
出处
《上海交通大学学报（医学版）》
CAS
CSCD
北大核心
2009年第3期334-337,共4页
Journal of Shanghai Jiao tong University:Medical Science
