脑创伤患者急性期皮质醇分泌的变化

Changes in cortisol secretion in the acute phase of traumatic brain injury

目的 探讨脑创伤患者急性期皮质醇（COR）分泌的变化.方法 创伤后2～24 h入院的脑创伤患者75例,根据Glasgow昏迷评分分为轻度脑创伤组（TBI1组,n=30）、中度脑创伤组（TBI2组,n=12）和重度脑创伤组（TBI3组,n=33）,13例同期住院的颈椎病或颅骨骨瘤患者为对照组（C组）.于入院后1 d时采集静脉血样,测定血清总COR、促肾上腺皮质激素和皮质醇结合球蛋白的浓度,计算游离COR浓度及游离COR指数.记录高血COR的发生情况.结果 与C组比较,TBI1组、TBI2组和TBI3组血清总COR、促肾上腺皮质激素、游离COR的浓度及游离COR指数均升高（P＜0.05）,且TBI2组和TBI3组高于TBI1组（P＜0.05）;四组间皮质醇结合球蛋白浓度比较差异无统计学意义（P＞0.05）.TBI1组、TBI2组和TBI3组高血COR发生率高于C组,且TBI3组高于TBI1组和TBI2组（P＜0.05）.结论 脑创伤患者急性期COR分泌升高,COR分泌水平与创伤程度有关.

Objective To investigate the changes in cortisol （COR） secretion in the acute phase of traumatic brain injury （TBI） .Method Seventy-five patients admitted to the hospital at 2-24 h after TBI were divided into 3 groups based on the Glasgow Coma Scale score： mild TBI group （group TBI1, n = 30）, moderate TBI group （group TBI2, n = 12） and severe TBI group （TBI3, n = 33）. Thirteen patients with cervical spondylosis or osteoma of the skull （admitted to the hospital at the same period） were regarded as control group （group C）. Venous blood samples were taken on the first day after admission to measure the serum concentrations of total COR, adrenocorticotropin （ACTH） and corticosteroid-binding globulin （CBG）. Free COR concentrations and free COR index were calculated. High blood COR was recorded. Result Compared with group C, the serum concentrations of total COR and ACTH, free COR levels and free COR index were significantly increased in TBI1, TBI2 and TBI3groups （P 〈 0.05）. The parameters mentioned above were significantly higher in TBI2 and TBI3 groups than in TBI1 group （ P 〈0.05）. There was no significant difference in serum CBG concentrations among the four groups.The incidence of high blood COR was significantly higher in TBI1, TBI2 and TBI3 groups than in C group, and in TBI3 group thanin TBI1 and TBI2 groups （P 〈0.05）. Conclusion COR secretion is increased in the acute phase of TBI and the level of COR secretion is related to the severity of brain damage.