重型颅脑损伤中远期垂体激素变化的临床因素分析

Analysis of clinical factors influencing mid-long term pituitary hormone levels in patients after severe traumatic brain injury

目的 探讨重型颅脑损伤中远期垂体激素变化的特点及临床影响因素. 方法 选择南方医院神经外科自2011年1月至2013年12月收治的79例重度颅脑损伤患者,在伤后6个月～2年回访检测垂体激素及皮质醇、睾酮、雌二醇、游离甲状腺素的基础水平,分析垂体激素异常改变的发生率及激素类型特点,采用单因素分析及多因素Logistic回归分析探讨影响重型颅脑损伤中远期垂体激素异常改变的相关临床因素. 结果 79例重度颅脑损伤患者中35例发生垂体激素异常改变,发生率为44.30％;激素类型主要包括催乳素（PRL） 18例（26.87％）、甲状腺激素（TSH）16例（23.88％）、促肾上腺皮质激素（ACTH）9例（13.43％）、生长激素（GH）8例（11.94％）、卵泡刺激素（FSH）10例（14.93％）、黄体生成素（LH）6例（8.96％）.多因素Logistic回归分析显示,重型颅脑损伤后中远期垂体激素异常改变的相关临床因素包括弥漫性损伤（OR=5.252,95％CI：1.176～23.465,P=0.030）、脑疝（OR=4.119,95％CI：1.261～13.452,P=0.019）、蛛网膜下腔出血（OR=3.966,95％CI：1.179～13.337,P=0.026）及颅底骨折（OR=4.222,95％CI：1.087～16.396,P=0.037）. 结论 重型颅脑损伤中远期易并发垂体激素异常改变,弥漫性损伤、脑疝、蛛网膜下腔出血及颅底骨折是其高危因素.

Objective To investigate the characteristics of mid-long term pituitary hormone abnormalities in patients after severe traumatic brain injury （TBI） and its influencing clinical factors.Methods A total of 79 patients with severe TBI,admitted to our hospital from January 2011 to December 2013,were chosen in our research.Their basal levels of pituitary hormones,cortisol,testosterone,estradiol and free thyroxine 4 were detected in 6 months to 2 years after injury;and their clinical data were retrospectively analyzed by Chi-square test and multivariate Logistic regression analysis was employed to explore the incidence and types of pituitary hormone abnormalities,and the possible influencing factors.Results There were 35 patients with pituitary hormone abnormalities in 79 patients,with an incidence of 44.30%;the types of pituitary hormone abnormalities included prolactin in 18 patients （26.87%）,thyroid stimulating hormone in 16 patients （23.88%）,adrenocorticotropic hormone in 9 （13.43%）,growth hormone in 8 （11.94%）,and follicle stimulating hormone in 10 （14.93%） and luteinizing hormone in 6 （8.96%）.Multivariate Logistic regression analysis showed that factors associated with pituitary hormone abnormalities following severe TBI in the mid-long term were diffused injury （OR=5.252,95%CI：1.176-23.465,P=0.030）,brain hernia （OR=4.119,95%CI：1.261-13.452,P=0.019）,subarachnoid hemorrhage （OR=3.966,95%CI：1.179-13.337,P=-0.026） and skull fracture （OR=4.222,95%CI：1.087-16.396,P=0.037）.Conclusion Pituitary hormones following severe TBI are likely to be abnormal,and diffused injury,brain hernia,subarachnoid hemorrhage and skull fracture are the risk factors.