成人创伤性脑损伤后垂体相关激素的变化及其临床意义

Changes of relative pituitary hormones and their significance in adults with traumatic brain injury

目的探讨成人创份性脑损伤（traumaticbraininjury，TBI）后垂体相关激素的变化及其临床意义。方法应用电化学发光法，对158例TBI患者血浆总皮质醇（plasmatotalcortisol，PrrC）、游离三碘甲状腺原氨酸（freetriiodothyronine，FT3）、游离甲状腺素（freethyroxine，FT4）、促甲状腺素（thyrotropin，TSH）、生长激素、卵泡生成激素（folliclestimulating hormone，FSH）、黄体生成激素（1uteinizinghormone，LH）、雌二醇、睾酮、催乳素进行定量分析和动态观察。结果催乳素、PTC水平伤后急性期升高，伤后3d逐渐降低。TSH、FT3、FT4伤后早期略降低，后逐渐回升。伤后FSH、LH、雌二醇、睾酮及生长激素变化不显著。GCS评分较低者垂体相关激素变化幅度较大。恢复期随访部分患者可有不同程度的激素下降，需激素替代治疗，日常生活活动能力（activityofdailyliving，ADL）差组左甲状腺素片替代治疗2例（2／6），醋酸泼尼松替代治疗1例（1／6），十一酸睾酮替代治疗2例（2／6）；ADL中组左甲状腺素片替代治疗2例（11％），1例醋酸泼尼松替代治疗（6％），十一酸睾酮替代治疗3例（17％）；ADL良组左甲状腺素片替代治疗2例（4％），十一酸睾酮替代治疗3例（6％）。预后不良患者可伴有持续催乳素升高。结论成人TBI后垂体相关激素变化与伤后时间和严重程度相关。催乳素异常与患者预后有一定的相关性。

Objective To investigate changes of relative pituitary hormones in adults with trau- matic brain injury （TBI） and the related clinical significance. Methods Quantitative analysis and dy- namic observation of relative pituitary hormones were performed in 158 TBI patients by electrochemical lu- minescence method. Measured indices included plasma total cortisol （PTC）, free triiodothyronine （FT3）, free thyroxine （FT4）, thyrotropin （TSH）, growth hormone, follicle stimulating hormone （FSH）, luteinizing hormone （LH）, estradiol, testosterone, and prolactin. Results Prolactin and PTC increased in the acute phase, but gradually reduced three days after trauma. TSH, FT3, and FT4 slightly decreased after trauma, followed by a gradual return. While there were no significant changes in FSH, LH, estradiol, testosterone, and growth hormone after trauma. Changes in relative pituitary hor- mones were more profound in patients with a lower GCS. Some patients presented different degree of re- duced hormones in recovery period and needed hormone replacement therapy. Among the patients with poor activity of daily living （ADL）, lvothyroxine replacement therapy was applied in 2 patients （2/6）, prednisone acetate in 1 （1/6）, and eleven acid testosterone in 2 （2/6）. Among patients with mild ADL, levothyroxine replacement therapy was applied in 2 patients （ 11% ）, prednisone acetate in 1 （6%）, and eleven acid testosterone in 3 （17%）. Among patients with good ADL, levothyroxine replacement therapy was applied in 2 patients （4%） and eleven acid testosterone in 3 （6%）. Persistent prolactin elevation was found in patients with poor outcome. Conclusions Changes of relative pituitary hormones in adult patients with TBI are associated with severity and duration of trauma. Abnormal prolactin level can affect outcome of the patients.