抗脑垂体抗体与脑外伤后垂体功能障碍的相关性研究

The relationship between the antipituitary antibodies （APAs） and hypopituitarism after traumatic brain injury

目的探讨抗脑垂体抗体（APAs）与脑外伤后垂体功能减退及脑损伤程度的关系。方法将73例脑外伤后9～12个月且垂体激素均有不同程度下降的患者按入院时格拉斯哥昏迷指数（GCS）评分分成A（3～8）、B（9—12）、C（13～15）3组，分别测定其血液中垂体激素[生长激素（GH）、总睾酮（TT）、游离三碘甲状腺原氨酸（F33）、促卵泡刺激素（FSH）／黄体生成素（LH）]和APAs水平。激素采用化学发光法测定，APAs采用酶联免疫吸附法（ELISA）检测。结果A组的APAs水平显著高于B、c组（P〈0．001），而B、c组间差异无统计学意义（P〉0．05）；A组所测激素的水平均显著低于B、c组（P〈0．001），而B、c组间差异无统计学意义（P〉0．05）。统计显示，患者APAs水平与GH水平呈负相关（r=-0．64071，P〈0．001），与GCS评分亦呈负相关（r=-0．50132，P〈0．001）。结论APAs的产生与脑外伤有关，损伤程度与APAs水平成正相关，与GH等垂体激素水平成负相关。结果表明通过测定APAs水平可以推测脑外伤后期脑垂体功能下降的概率和程度。

Objective To investigate the relationship between antipituitary antibodies （APAs） and hypopituiarism following traumatic brain injury （TBI）, as well as the severity of brain injury. Methods The study included 73 patients who suffered TBI 9 to 12 months ago and were diagnosed with hypopituitarism during the follow-up. Based on their Glasgow Coma Scale （GCS） on admission they were categorized into three groups ： A （ 3-8 ）, B （ 9-12 ） and C （ 13 - 15 ）. Levels of plasma pituitary hormones （ GH, TT, TF3 and FSH/LH） and APAs were measured in all patients with chemiluminescence assays and ELISA, respectively. Results Patients in group A had higher levels of APAs and lower levels of hormones compared with those in group B （P〈0.001） or group C （P〈0. 001 ） ,while no significant difference was found between group B and group C for levels of either APAs （ P〉0.05 ） or hormones （ P〉0.05 ）. Levels of APAs were negatively correlated with both GH （ r= -0.64071 ,P〈0. 001 ） and GCS （ r= -0. 50132 ,P〈0. 001 ）. Conclusion The present investigation provides preliminary evidence that APAs may be associated with the development of TBI-induced hypopituiarism. It suggests that the severity of hypopituiarism following TBI could be predicted by measuring the level of APAs.