以颅脑创伤为主男性创伤患者早期血清孕酮变化及意义

Changes and clinical significance of serum progesterone at the early stage in male injury patients complicating with craniocerebral trauma

目的研究以颅脑创伤为主的男性创伤患者早期血清孕酮的变化特点与临床意义。方法收集急诊就诊的男性急性创伤患者90例作为观察对象，按ISS评分对创伤严重程度予以评分分组，按GCS评分对合并颅脑创伤患者进行评分分组；分别在伤后12h内、24h及72h采集外周静脉血，采用放射免疫双抗体沉淀法测定血清孕酮水平。同时各分组间比较血清孕酮水平变化，并与15例健康查体男性对照组进行比较。结果伤后12h内创伤患者创伤越重，血清孕酮水平升高越明显，其中严重创伤组（ISS〉25分）孕酮水平明显高于对照组（P〈0．05）；合并颅脑创伤的3分≤GCS≤5分组与5分〈GCS≤8分组均明显高于对照组（P〈0．01）。伤后24h血清孕酮水平开始下降。伤后72h严重创伤组及3分≤GCS≤5分组孕酮水平均明显低于对照组（分别为P〈0．05，P〈0．01），但5分〈GCS≤8分组与对照组比较差异无统计学意义。结论严重创伤及颅脑创伤男性患者早期血清孕酮水平的改变与创伤严重度特别是颅脑创伤的严重程度相关，该现象为临床应用孕酮修复中枢神经损伤提供一定的基础资料。

Objective To explore the changes and clinical significance of serum progesterone at the early trauma stage in male injury patients complicating with craniocerebral trauma. Methods 90 male injury patients with craniocerebral trauma were enrolled in this study; the severity of multiple injury was evaluated and grouped according to injury severity score（ ISS）, while the severity of craniocerebral trauma according to Glasgow coma score （GCS）. Levels of serum progesterone were tested by radioimmunoassay double antibody precipitation at the three time - points ： within 12, 24 and 72 h after the trauma for all the patients. 15 healthy male volunteers were enrolled as the control. Results For the multiple injury patients, the more serious the trauma was, the higher serum progesterone level wass; the severe trauma group （ ISS 〉 25 ） had the apparently higher level of serum progesterone than the control group （P 〈0.05）. For the craniocerebral trauma patients, both 3 ≤GCS≤5 and 5 〈 GCS≤8 group had the higher level of serum progesterone than the control group （P 〈0. Ol ）. We found that level of serum progesterone decreased 24 h after the trauma. At 72 h after the trauma, levels of serum progesterone in both 5 〈 GCS ≤ 8 and 3 ≤ GCS ≤ 5 group were significantly lower than those in the control group （ P 〈 0. 05, P 〈 0.01 ）. Meanwhile, there was no statistical difference in progesterone between the 5 〈 GCS ≤ 8 group and the control group （ P 〉 0.05 ）. Conclusion Level of serum progesterone correlated with the severity in male multiple injury patients complicating with craniocerebral trauma, which indicates that progesterone could be applied to the treatment of central nerve injury.