创伤性颅脑损伤后垂体前叶相关激素变化研究

发布时间：2018-07-05 07:54

本文选题：创伤性颅脑损伤 + 垂体前叶激素　；参考：《皖南医学院》2017年硕士论文

【摘要】：目的:通过测定创伤性颅脑损伤(traumatic brain injury,TBI)患者在受伤后不同时间点的血清中促甲状腺激素(TSH)、生长激素(GH)、卵泡刺激素(FSH)、泌乳素(PRL)、促肾上腺皮质激素(ACTH)的含量,探讨分析垂体前叶相关激素的变化以及与患者伤情严重程度和预后之间的相互关系。为TBI患者伤后垂体前叶相关激素异常的临床诊断和相关激素替代治疗提供更多的理论支持。方法:选取皖南医学院附属弋矶山医院神经外科2015年10月至2016.10月期间收住入院的TBI患者病例资料,并依据纳入标准和排除标准,选取其中符合条件的128例病例资料,根据患者入院时的病情严重程度并依据格拉斯哥昏迷评分标准(Glasgow coma scale,GCS)分组:参照GCS分数,13到15分评为轻度,共36例,9到12分评为中度,共44例,6到8分评为重度,共26例,3到5分为特重度,共22例;通过分别测定其在受伤后第1天,第3天,第7天和第14天的血清中GH、TSH、FSH、PRL和ACTH的含量,动态监测TBI患者在受伤后不同时间点的激素含量改变,并分析与患者病情和以后预后转归之间的相关关系。另外从本院体检中心选取40例既往无相关内分泌系统疾病病史的健康体检者作为本次研究的对照组。结果:本次研究中对所有TBI患者在受伤后不同时间点(第1、3、7、14天)内进行各个激素含量的检测,GH、FSH以及ACTH异常的发生率最高,而TSH和PRL在伤后异常的发生率相对较低;GH、TSH、ACTH、FSH、PRL含量在伤后均出现升高,主要集中在前三天,尤其GH、ACTH和FSH,变化更是明显,第1、3天含量明显高于对照组,差异有统计学意义,一周后所有激素均开始逐渐恢复;轻中度患者在伤后各个激素均有所升高,但总体幅度不大,重度和特重度TBI患者在伤后的激素含量增长幅度大,比对照组高出很多,差别有统计学意义;预后不良组患者的激素含量与预后良好组相比,预后不良组患者GH在第1、2天的含量与预后良好组相比有统计学意义,TSH和PRL仅在受伤后第1天的含量与预后良好组相比有统计学意义,而ACTH在受伤后第1、3、7天的含量与预后良好组相比具有统计学意义,而FSH在受伤后第1、3、7、14的含量与预后良好组相比均有统计学意义。结论:(1)TBI患者在伤后垂体前叶分泌的相关激素含量会有异常,最常见的是GH、FSH以及ACTH的异常;(2)TBI患者伤后出现的激素异常主要在前三天,各激素含量变化最明显,后逐渐开始恢复;(3)轻度TBI患者的激素含量变化一般不是很明显,无重要的临床意义,重度和特重度TBI患者激素含量变化大,与病情本身严重程度呈密切相关,有重要的临床参考意义;(4)TBI患者伤后激素含量的改变对病人的预后评估有很重要的临床价值,伤后第1、3天出现激素含量明显的异常,多提示预后不理想,相反,激素含量变化幅度不大,呈现比较平稳的状态,多提示预后良好。
[Abstract]:Objective: to determine the serum levels of thyrotropin (TSH), growth hormone (GH), follicle stimulating hormone (FSH), prolactin (PRL) and adrenocorticotropic hormone (ACTH) in patients with traumatic brain injury (traumatic brain injury-induced) at different time points after injury. To explore the relationship between the changes of pituitary anterior lobe related hormones and the severity of injury and prognosis. To provide more theoretical support for the clinical diagnosis and hormone replacement therapy of pituitary anterior lobe related hormone abnormalities in patients with TBI. Methods: the data of TBI patients admitted to hospital from October 2015 to October 2016 were selected, and 128 eligible cases were selected according to the inclusion criteria and exclusion criteria. According to the severity of admission and Glasgow coma scale (Glasgow coma scale), 36 patients were rated as mild, 36 patients scored 9 to 12 as moderate, and 44 patients scored 6 to 8 as severe, compared with GCS scores of 13 to 15. A total of 26 patients were divided into three to five groups, 22 patients were divided into two groups. The serum levels of GHTSHFSHPRL and ACTH were measured on day 1, day 3, day 7 and day 14, respectively, to dynamically monitor the changes of hormone levels in patients with TBI at different time points after injury. And to analyze the correlation between the patient's condition and prognosis. In addition, 40 healthy persons with no history of endocrine system diseases were selected as the control group. Results: in this study, all TBI patients had the highest incidence of abnormal levels of GHH and ACTH at different time points after injury (day 1, day 3, 7 ~ 14). However, the incidence of abnormal TSH and PRL after injury was relatively low. The contents of TSH and PRL increased after injury, mainly in the first three days, especially in the first three days. The levels of TSH and PRL on the 3rd day were significantly higher than those in the control group (P < 0.05), and the difference was statistically significant. After one week, all hormones began to recover gradually; all hormones increased in mild and moderate patients after injury, but the overall range was not large. The levels of hormones in patients with severe and especially severe TBI increased significantly after injury, which was much higher than that in the control group. The difference was statistically significant. The hormone content in patients with poor prognosis was higher than that in patients with good prognosis. The levels of GH in the poor prognosis group were significantly higher than those in the good prognosis group on the 1st day, and the levels of TSH and PRL on the first day after injury were significantly higher than those in the good prognosis group. The content of ACTH on the 1st day after injury was significantly higher than that in the group with good prognosis, while the content of FSH in the 1st day of injury was significantly higher than that in the group with good prognosis. Conclusion: (1) the levels of hormones secreted in anterior pituitary of TBI patients will be abnormal after injury, and the abnormalities of GHFSH and ACTH are the most common. (2) the changes of hormone levels in TBI patients are most obvious in the first three days. (3) the changes of hormone content in patients with mild TBI are not obvious and have no important clinical significance. The changes of hormone content in patients with severe and especially severe TBI are closely related to the severity of the disease itself. (4) the changes of hormone content in TBI patients after injury have important clinical value for the prognosis evaluation of the patients. There are obvious abnormal hormone levels on the 1st day after injury, indicating that the prognosis is not good, on the contrary, the changes of hormone content in TBI patients are very important. The change of hormone content is not large, showing a relatively stable state, indicating that the prognosis is good.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15

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