颅脑损伤患者血清甲状腺素和和肽素的变化

Changes in serum levels of thyroid hormones and copeptin in patients with severe traumatic brain injury

目的观察颅脑损伤(TBI)患者血清甲状腺激素和和肽素的变化。方法 2015年3月至2016年6月我院重症监护病房收治TBI患者56例,其中重型TBI(GCS评分6~8分)18例,特重型(GCS评分3~5分)38例。选取同期健康体检者30例作为正常对照组。入院24 h采集静脉血离心后取血清,化学发光法测定与垂体功能相关的激素分泌水平,包括游离三碘甲状腺原氨酸(FT3)、四碘甲状腺原氨酸(FT4)、促甲状腺素(TSH)和和肽素。结果与正常对照组相比,TBI患者血清TSH、FT3和FT4浓度分别降低52.60%、49.14%和40.10%,和肽素浓度增加775.45%,差异具有统计学意义(P<0.05)。重型TBI患者血清TSH、FT3和FT4浓度均显著高于特重型患者(P<0.05),而血清和肽素浓度显著高于特重型患者(P<0.05)。结论急性重型、特重型TBI患者早期下丘脑-腺垂体-甲状腺轴功能降低,而下丘脑-神经垂体-抗利尿激素系统功能亢进;下丘脑-神经垂体-抗利尿激素系统功能亢进可能是导致TBI患者预后不良的原因之一。

Objective To observe the changes in serum levels of thyroid hormones and copeptin and their effect on the prognoses in the patients with severe traumatic brain injury （TBI）. Method The serum levels of thyroid hormones including thyroid-stimnlating hormone （TSH）, free triiodothyronine （FT3） and free tetraidothyronina （FT4） and copeptin were determined by chemiluminescence method and ELISA respectively, in 56 patients with severe TBI treated in our hospital from March, 2015 to June, 2016 and 30 healthful subjects serving as control group. Result The serum levels of TSH, FT3 and FT4 were significantly lower, and the serum level of copeptin was significantly higher in the patients with severe TBI than those in the control group 24 hours after TBI （P〈0.05）. The serum levels of TSH, FT3 and FT4 were significantly higher, and the serum level of copeptin was significantly lower in 18 patients with GCS score of 6~8 points than those in 38 patients with GCS score of 3~5 points 24 hours after TBI （P〈0.05）. Conclusion It is suggested that in the patients with severe TBI the hypothalamic pituitary- thyroid axis is hypofunctional and the hypothalamic pituitary arginine vasopressin （AVP） system is hyperfunctional. Maybe the hyperfunctional hypothalamic pituitary AVP system is the important reason for the poor prognoses in the patients with severe TBI.