重型颅脑损伤患者垂体前叶激素水平及MRI改变的临床分析

Clinical Analysis of Anterior Pituitary Hormone Levels and MRI Changes in Patients with Severe Traumatic Brain Injury

目的探讨重型颅脑损伤(sTBI)患者垂体前叶激素水平及MRI影像学改变与预后的关系。方法收集53例sTBI患者(观察组),分别于入院当天、第3天、第7天、第14天抽取外周静脉血,测定血中生长激素(GH)、促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)、卵泡刺激素(FSH)、黄体生成素(LH)和催乳素(PRL)的含量,观察激素水平动态变化;分析患者的预后、垂体MRI改变与激素水平的关系。结果观察组GH、ACTH、FSH、LH和PRL水平呈上升趋势,而TSH水平呈下降趋势,但均于14 d左右恢复正常水平,观察组激素水平大部分时间点均高于对照组,差异有统计学意义(P<0.05)。随访3个月,观察组53例患者中死亡9例、后遗症状态生存17例、痊愈27例。死亡亚组上述激素水平最高,后遗症生存亚组次之,痊愈亚组激素水平最低,各组间大部分时间点差异有统计学意义(P<0.05)。本组病例中共21例出现MRI改变。创伤后早期,垂体在MRI上主要表现为挫裂伤及出血性改变。死亡亚组患者7例(77.78%)出现上述改变,后遗症生存亚组8例(47.06%)出现上述改变,而痊愈亚组仅6例(22.22%)出现上述改变,各亚组之间比例的差异有统计学意义(χ2=9.222,P<0.05)。MRI改变亚组激素水平在大部分时间点均高于无MRI改变亚组,差异有统计学意义(P<0.05)。此外,大部分时间点激素水平与MRI影像学变化存在正相关关系。结论 sTBI患者体内垂体前叶激素水平较高,高激素水平者预后较差;sTBI患者垂体前叶激素水平和MRI可能作为判断预后的参考依据。

Objective To explore the relationship between the anterior pituitary hormone levels, MRI changes with the prognosis of severe traumat- ic brain injury （sTBI）. Methods 53 patients with sTBI were selected for the study, and the growth hormone （ GH ）, adrenocorticotropic hormone （ACTH）, thyroid stimulating hormone （TSH）, follicle stimulating hormone （FSH）, luteinizing hormone （LH） and prolactin （PRL） in peripheral blood was tested on the day of admission （D0）, the 3rd day （ D3 ）, the 7th day （ D7 ）, and 14th day （ D14 ）. The dynamic changes were observed. Be- sides that, we analyzed the relationship among the prognosis, the pituitary MRI changes and the hormone levels. Results The GH, ACTH, FSH, LH and PRL presented a risen trend, while the TSH was decreased, but all of them returned to normal level on D14. The hormone levels in observation group were higher than control group on most time points, the differences were statistically significant （all P 〈 0.05 ）. After a three-month follow up, 9 cases died, 17 cases lived with sequela, and 27 eases were cured. The hormone levels in death subgroup were higher than both sequela subgroup and cure subgroup. The differences were statistically significant at most time points （P 〈 0.05 ）. Totally, 21 cases with MRI changes were seen, where a contusion or hemorrhage manifestation was observed in pituitary in early stage, including 7 cases （77.78%） in death subgroup, 8 cases （47.06%） in sequela subgroup and 6 cases （ 22.22% ） in cure subgroup. The difference was statistically significant （ Xχ2=9.222, P 〈 0.05 ）. The hor- mone levels in patients with MRI changes were higher than these without MRI changes. The difference was statistically significant on most time points （P 〈 0.05 ）. Moreover, there was a positive correlation between hormone levels and MRI changes on most time points. Conclusion The sTBI pa- tients with a higher anterior pituitary hormone levels and/or MRI changes exhibited a worse prognosis. It could provide reference to predict treatment outcome in sTBI patients by testing hormone levels and MRI image.