席汉综合征患者救治过程中发生精神症状的危险因素

A study of risk factors of psychiatric symptoms occurring in treating Sheehan＇s syndrome patients

目的探讨席汉综合征患者救治过程中发生精神症状的危险因素。方法收集2002年1月至2014年11月在中南大学湘雅二医院内分泌科确诊为席汉综合征的119例住院患者的临床资料。采用Logistic回归分析探讨席汉综合征患者救治中出现精神症状的危险因素。结果119例席汉综合征患者中，64例并发垂体危象（54％）；而在席汉综合征救治中，42例发生精神症状（35％）。与无精神症状发生患者比较，119例席汉综合征患者救治中发生精神症状患者的血红蛋白[（96±16）g／L比（104±22）g／L，P〈0．05]、血钠[（117±12）mmol／L比（127±12）mmol／L，P〈0．01]、血游离T3（FT3）[（1．4±1．0）pmol／L比（2．1±1．3）pmol／L，P〈0．01]、血游离T4（FT4）[（4．1±2．8）pmol／L比（6．5±4．9）pmol／L，P〈0．05]均低，而第1—3天氢化可的松的日用量均高（P〈0．05）。精神症状出现时，患者氢化可的松的前3d日均用量为165mg，垂体危象患者出现精神症状的氢化可的松前3d日均用量208mg。Logistic回归分析显示：血钠水平（P〈0．05，OR〈1）及第1天氢化可的松的日用量（P〈0．01，OR〉1）最终进入回归方程式，说明血钠水平（OR=0．950）是发生精神症状的保护因素，而第1天氢化可的松用量（OR=1．008）是发生精神症状的危险因素。结论垂体前叶功能受累严重，特别是并发垂体危象的患者容易在救治过程中发生精神症状。糖皮质激素的用量，特别是第1天的用量是精神症状发生的危险因素。

Objective To investigate the risk factors of psychiatric symptoms in the process of the treatment of Sheehan＇s Syndrome（SS）. Methods We collected the clinical data of 119 inpatients diagnosed of SS in Department of Endocrinology, the Second Xiangya Hospital, Central South University from January 2002 to November 2014. Logistic regression analyses were applied to investigate the risk factors of psychoses during the treatment of SS. Results We found that among all the 119 subjects, 64 （54%） out of the pathients developed into pituitary crisis over the course of treatment for SS. And, 42 （35%） of the patients had psychiatric symptoms. SS patients with psychiatric symptoms had lower levels of hemoglobin [ （96 ± 16） g/Lvs （104_±23） g/L,（P〈0.05）], sodium [（117 ,±12） mmol/L vs （127 ,±12） mmo]/L,（P 〈 0. 01 ） ], free serum T3 （ FT3 ） [ （ 1.4 ± 1.0） pmol/L vs （2. 1 ± 1.3 ） pmol/L, （ P 〈 0. 01 ） ] and free serum T4 （ FT4 ） [ （4. 1 ± 2. 8 ） pmol/L vs （ 6. 5 ± 4. 9 ） pmol/L, （ P 〈 0. 05 ） ] , but higher levels of daily dosage of hydrocortisone for the first three days （ P 〈 0.05 ） compared to the group without the same. Upon occurrence of psychiatric symptoms, the daily dosage of hydrocortisone for the first three days was 165 rag. Among them, patients also with pituitary crisis had a higher requirement of hydrocortisone, that is, daily dosage of hydroeortisone for the first three days was 208 mg. Logistic regression analysis showed that sodium（ P 〈 0. 05, OR 〈 1 ） and hydrocortisone dosage of the first day （ P 〈 0. 01, OR 〉 1 ） were included in the logistic regression equation, suggesting that serum sodium, is a protective factor against psychiatric symptoms （ OR = 0. 950）. And the dosage of glucocorticoid required on the first day （ OR = 1. 008 ） is a risk factor for psychiatric symptoms. Conclusion SS patients with severe anterior pituitary dysfuncthion, especially those with pituitary crisis are susceptible to have psychiatric symptoms during glucocorticoid treatment. The dosage of glucocorticoid, especially the first day dosage is one of the risk factors for psychiatric symptoms.