弥漫性轴索损伤后垂体功能不全的临床研究

Evaluation of chronic hypopituitarism following diffuse axonal injury

目的观察弥漫性轴索损伤(DAI)后垂体前叶主要激素的动态变化,为临床患者"激素替代治疗"提供理论依据。方法前瞻性收集经头颅MR证实的DAI患者85例和14例正常对照者,根据病灶发生部位将实验组分为轻、中、重3组。伤后3月和6月行GOSE评分评估预后,同期应用化学发光分析法检测患者血清泌乳素(PRL)、促肾上腺皮质激素(ACTH)、生长激素(GH)及促甲状腺素(TSH)。结果实验组中,轻、中、重3组垂体激素水平下降的发生率伤后3个月分别为9.1%、29.0%、38.1%,伤后6个月为6.1%、10.0%、36.8%;对照组未见垂体激素水平低下现象。实验组根据GOSE评分,伤后6个月预后良好组51例、不良组34例,两组激素水平低下发生率分别为7.8%、25.8%。两组中ACTH、GH及TSH水平存在统计学差异(P<0.05),PRL水平无统计学差异(P>0.05)。结论轻中型DAI患者慢性期可发生垂体前叶功能不全,但随康复时间延长大部分可恢复正常;重型患者垂体前叶功能不全发生率高且恢复率低。此外,部分垂体前叶激素水平的下降可影响患者的预后和康复。

Objective To investigate the dynamic change of anterior pituitary hormones and the prevalence of post-traumatic hypopituitarism （PTH） following diffuse axonal injury （DAI） in chronic stage. Methods Prospective cohort study was performed in 85 patients with DAI and 14 normal persons. In 3 and 6 months after head injury, the follow-up prognosis was evaluated and several major anterior pituitary hormones （PRL, ACTH, GH, TSH） were evaluated. Results The prevalence of PTH in mild, moderate and severe observation group after 3 months was 9.1%, 29.0% and 38.1% respectively. The prevalence was decreased to 6.1%,10.0% and 36.8% in 6 months after injury. PTH was not observed in control group. GOSE score in 6 months after injury was used to evaluate the prognosis. The observation group was divided into good group （n=51） and poor group （n= 34）. The incidence of PTH was 7.8% in good group, while in poor group it was 25.8%. The level of ACTH, GH and TSH in poor group was lower than that in good group （P〈0.05）. The difference of PRL was not found between above two groups （P〉0.05）. Conclusion These findings suggest that PTH occurs often in patients with severe DAI. PTH can occur in mild or moderate DAI patients. However, it may return to normal later. The high prevalence of PTH was observed in severe DAI patients, and the PTH seldom returen to normal in this group.