儿童重型颅脑损伤后垂体激素变化及亚低温治疗疗效分析

Changes in relative pituitary hormones following severe traumatic brain injury in children and mild hypothermia treatment

目的研究儿童重型颅脑损伤（STBI）后垂体相关激素分泌变化，探讨亚低温治疗对患儿近、远期垂体功能的影响。方法选择聊城市人民医院脑科医院自2011年6月至2015年1月收治的出现垂体相关激素分泌异常的儿童STBI患者83例，根据患者及家属意愿分为亚低温治疗组（42例）、常规治疗组（41例）。2组患者均于人院时及伤后第1、3、5、7、14天清晨检测静脉血生长激素（GH）、泌乳素（PRL）、促肾上腺皮质激素（ACTH）、游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺激素（TSH）水平，伤后6个月行格拉斯哥预后评分（GOS）并再次采集静脉血检查垂体相关激素水平。结果83例患者中单项激素紊乱31例（30．10％），2项以上紊乱52例（50．48％），发生率排前3位的激素分别为PRL、ACTH、GH。伤后第3、5、7天，亚低温治疗组患者血清PRL、ACTH水平均低于常规治疗组，差异均有统计学意义（P〈0．051；伤后第3天，亚低温治疗组患者恤清FT3水平低于常规治疗组，差异有统计学意义（P〈0．05）。伤后6个月常规治疗组、亚低温治疗组患者GOS评分分别为3．04±0．38、4．56±0．62，差异有统计学意义（P〈0.05）：亚低温治疗组患者垂体功能低下的发生率（16．67％）明显低于常规治疗组（46．88％），差异有统计学意义（P〈0．05）。结论儿童STBI后有较高的垂体功能异常发生率，亚低温治疗可有效改善早期垂体相关激素分泌紊乱程度，降低后期垂体功能低下的发生率。

Objective To observe changes in relative pituitary hormones after severe traumatic brain injury （STBI） in children and to investigate the short- and long-term effects of mild hypothermia on pituitary function. Methods Included for this study were 81 children who had been admitted to the Brain Hospital of Liaocheng People＇s Hospital from June 2011 to January 2015 for STBI and abnormal secretion of pituitary-related hormones. They were divided by the wishes of patients and their families into 2 groups, subjected to mild hypothermia treatment （n=42） or conventional treatment （n=41）. The levels were examined of growth hormone （GH）, prolactin （PRL）, adrenocorticotropic hormone （ACTH）, free triiodothyronine （FT3）, free thyroxine （FT4） and thyroid stimulating hormone （TSH） for both groups unpon admission and in the morning of 1, 3, 5, 7 and 14 days after injury. At 6 months after injury the patients were followed up for Glasgow Outcome Score （GOS） and levels of pituitary-related hormones. Results Of the 83 patients, disturbance of one single hormone was found in 31 （30.10%） and disturbance of 2 or more hormones in 52 （50.48%）. The top 3 hormones disturbed were PRL, ACTH and GH. On days 3, 5 and 7 after injury, the levels of PRL and ACTH in the mild hypothermia treatment group were significantly lower than in the conventional treatment group （P〈0.05）. On day 3 after injury, the level of FT3 in the mild hypothermia treatment group was significantly lower than in the conventional treatment group （P〈0.05）. At 6 months after injury, the GOS score for the conventional treatment group was 3.04±0.38, significantly lower than that for the mild hypothermia treatment group （4.56±0.62） （P〈 0.05）. The incidence of hypopituitarism in the hypothermia treatment group （16.67%） was significantly lower than in the conventional treatment group （46.88%） （P〈0.05）. Conclusions Incidence of pituitary dysfunction is high in children following severe traumatic brain injury. Mild hypothermia treatment can effectively alleviate early-stage parasecretion of pituitary hormones, and decrease the incidence of later pituitary dysfimction.