多发伤患者不同程度脊髓损伤对肾上腺形态及功能的影响

Effects of different degrees of spinal cord injury on adrenal morphology and function in patients with multiple trauma

目的探讨多发伤患者不同程度脊髓损伤(SCI)对肾上腺形态及功能的影响。方法选取2021年11月至2023年11月遵义医科大学附属医院创伤中心收治的145例多发伤伴SCI患者为研究对象,根据损伤严重程度评分(ISS)将其分为轻伤组(ISS评分<16分)和重伤组(ISS评分≥16分),并按美国脊髓损伤协会(ASIA)标准对SCI程度进行分级。比较两组的血红蛋白(Hb)水平及肾上腺体积;比较两组中不同SCI分级患者的皮质醇及促肾上腺皮质激素(ACTH)水平。结果多发伤伴SCI患者中,轻伤68例,重伤77例。轻伤组的ISS评分低于重伤组,Hb水平高于重伤组(P<0.05)。SCI分级显示,48例为A级,39例为B级,26例为C级,32例为D级;两组中,不同SCI分级患者的皮质醇、ACTH水平比较,差异无统计学意义(P>0.05);轻伤组的皮质醇、ACTH水平高于重伤组(P<0.05)。两组的肾上腺左侧、右侧及总体积比较,差异无统计学意义(P>0.05)。结论急性SCI短期内不会导致肾上腺体积的相对变化,严重多发伤患者更容易表现出肾上腺功能不全。

Objective To explore the effects of different degrees of spinal cord injury(SCI)on adrenal morphology and function in patients with multiple trauma.Methods A total of 145 patients with multiple trauma and SCI admitted in the trauma center of the Affiliated Hospital of Zunyi Medical University from November 2021 to November 2023 were selected as the research objects.According to the Injury Severity Score(ISS),the patients were divided into mild trauma group(ISS score<16 points)and severe trauma group(ISS score≥16 points),and the degree of SCI was graded according to the American Spinal Injury Association(ASIA)standard.The levels of hemoglobin(Hb)and adrenal volume were compared between the two groups;the levels of cortisol and adrenocorticotropic hormone(ACTH)in patients with different SCI grades were compared between the two groups.Results There were 68 cases of mild trauma and 77 cases of severe trauma in patients with multiple trauma and SCI.The ISS score of the mild trauma group was lower than that of the severe trauma group,and the Hb level was higher than that of the severe trauma group(P<0.05).SCI classification showed that 48 cases were grade A,39 cases were grade B,26 cases were grade C,and 32 cases were grade D;there were no significant differences in cortisol and ACTH levels between patients with different SCI grades in the two groups(P>0.05);the levels of cortisol and ACTH in the mild trauma group were higher than those in the severe trauma group(P<0.05).There were no significant differences in the left,right and total volume of adrenal gland between the two groups(P>0.05).Conclusion Acute SCI does not lead to relative changes in adrenal volume in the short term,and patients with severe multiple trauma are more likely to show adrenal insufficiency.