颅脑损伤昏迷患者血清褪黑素水平变化及其临床意义

Clinical Significance of Serum Melatonin in Patients with Traumatic Brain Injury

目的探讨不同病情的成年颅脑损伤昏迷患者血清褪黑素水平变化的临床意义。方法选择61例成年颅脑损伤且昏迷患者,根据入院时GCS评分分为特重型、重型及中型三组进行研究。同时选择31例成年健康志愿者作为对照组。颅脑损伤组分别在入院后第1、37、日早晨6:00,下午16:00采集2次血标本并测定其MT水平。根据不同转归,在出院时及出院后3个月,分别对颅脑损伤组各组间及其与对照组之间进行比较。结果至出院,全组存活48例,死亡13例,死亡病例死亡前平均血清褪黑素水平为19.1±9.8pg/ml。各颅脑损伤组血清MT水平在损伤后各时间点均显著低于对照组(P<0.05),各时间点重型组和特重型组的MT水平显著低于中型组(P<0.05),特重型组的MT水平又显著低于重型组(P<0.05)。结论颅脑损伤患者血清MT水平越低,颅脑损伤的病情越重,GOS预后评分越低,患者的伤残程度越重。

Objective To investigate the clinical significance of serum melatonin in adult patients with traumatic brain injury （TBI）. Methods 61 adult patients with traumatic brain injury and coma, according to their GCS scores on admission, were divided into supper-severe injury, severe injury and moderate injury groups. 31 cases of adult healthy volunteers were selected as the control group. Samples were collected 2 times at dayl ,3 and 7 after admission The prognosis of these patients were evaluated in 3 months after discharge. Results 48 patients survived from TBI. The average level of serum melatonin in control, supper-severe injury, severe, moderate groups were 106.6±14.3,24.2 ± 7.7,44.7±26. 4and69.2 ±19.5 pg/ml respectively. The average level of serum melatonin in dead cases was 19.1 ± 9.81 pg/ml. GCS scores of TBI groups acquired at discharge data and 3 months after discharge were proportional with theirs serum melatonin levels. Conclusion Lower serum melatonin levels indicate worse condition and lower GCS scores suggest more incidences of coma and disability in TBI patients.