男性多发伤患者早期血清泌乳素变化及临床意义

Changes and clinical significance of serum prolactin in the early stage for male multiple injury patients

目的研究男性多发伤特别是颅脑创伤患者早期血清泌乳素(PRL)变化特点与临床意义。方法收集男性多发创伤患者90例,按照创伤严重评分(ISS)对多发伤严重程度予以评分分组,按格拉斯哥评分(GCS)对合并颅脑损伤患者进行评分分组;分别在伤后12 h内、第24及72 h测定血清PRL含量并进行组间比较;以15例同龄段健康男性为对照组。结果对照组的PRL含量为(212.7±77.7)mU/L;多发创伤患者在伤后24 h内创伤越重,血清PRL水平升高越明显,其中在伤后12～24 h ISS评分分值越高血清PRL含量升高越明显;ISS<16分组(A组)、25分≥ISS≥16分组(B组)及ISS>25分组(C组)与对照组比较差异有统计学意义(P<0.05),且各组间两两比较差异有统计学意义(P<0.05);至伤后72 h三组患者血清PRL水平下降,与对照组比较差异有统计学意义(P<0.05)。合并颅脑损伤的5分≥GCS≥3分组与8分≥GCS>5分组均明显高于对照组(P<0.01);伤后72 h各组血清PRL水平开始下降。结论严重创伤及颅脑损伤男性患者早期血清泌乳素水平的改变与创伤严重度特别是颅脑损伤的严重程度有关,提示血清泌乳素有望作为评估男性多发伤患者创伤严重程度的参考指标。

Objective To explore the changes and clinical significance of serum prolactin （PRL） in the early trauma stage for male multiple injury patients complicating with craniocerebral trauma. Methods Ninety male multiple injury patients complicating with craniocerebral trauma were enrolled in this study; the severity of multiple injury was evaluated and grouped via injury severity score （ISS）, while the severity of craniocerebral trauma via Glasgow coma score （GCS）. Levels of serum prelactin were tested through radioimmunoassay double antibody precipitation at the three time-points： within 12, 24 and 72 h after injury for all the subjects. Besides, 15 healthy male volunteers were enrolled as the control. Results The level of PRL for the control group was （212.7±77.7） mU/L. For the multiple injury patients, the more serious of trauma, the higher level of PRL. The ISS〈16 scores group （group A）, 25 scores≥ISS≥ 16 scores group （group B） and 25 scores≥ISS≥16 scores group （group C） had the apparently higher PRL level than those of the control group （P 〈 0.05）; the difference between any two of group A, B and C was signifant （P 〈 0.05）. At 72 h after trauma, PRL level decreased but was still higher than the control （P 〈 0.05）. For the craniocerebral trauma patients, both 5 scores ≥GCS ≥3 scores and 8 scores ≥ GCS〉5 scores group had the higher level of serum prolactin than the control group （P 〈 0.01）. At 72 h after trauma, levels of serum prolactin of both 5 scores≥GCS≥3 scores and 8 scores≥ GCS〉5 scores group were significantly lower than those within 12 h and at 24 h （P 〈 0.01）. Conclusion Level of serum prolactin correlated with the severity in the early stage for male multiple injury patients complicating with craniocerebral trauma, indicating that prolactin could be a novel reference factor for evaluating the severity of multiple injury.