不同时间点测定血浆皮质醇水平在自发性脑出血患者的应用及评价

发布时间：2019-06-19 06:28

【摘要】：目的对自发性脑出血患者不同时间点检测血浆皮质醇水平,了解其与疾病发展和预后的关系,为临床治疗提供理论依据。方法选择自发性脑出血患者45例为研究对象,按GCS评分标准将患者分为轻-中型组和重-特重型组两组,其中轻-中型组32例,重-特重型组13例。于发病后第1、3、7、10和14天分别抽取患者静脉血连续测定皮质醇(COR)、促肾上腺皮质激素(ACTH)、总皮质醇(TC)、皮质醇结合球蛋白(CBG)含量,FC和FCI通过TC及CBG值计算得出。结果 (1)重-特重型组和轻-中型组患者血浆ACTH、COR在自发性脑出血第1、3、7、10和14天均有不同程度升高,在第1天内达到高峰,然后随着时间逐渐降低,两组之间差异有统计学意义(P0.05,P0.01);重-特重型组血浆COR和ACTH水平与轻-中型组相比时间越长下降越明显,COR和ACTH水平两者之间具有良好的相关性。(2)发病后第1天TC、FC的FCI均显著增高(P0.01),后逐渐下降;轻-中型组TC发病后第10天左右降到正常参考范围,而重-特重型组还高于正常参考范围。轻-中型组和重-特重型组中CBG于发病后第1天比较差异无统计学意义(P0.05),后逐渐升高并有统计学意义(P0.01)。(3)两组入院时GCS评分、Graeb评分、出血量比较差异均有统计学意义(P0.05);其中重-特重型组患者入院时GCS评分低于轻-中型组,Graeb评分和出血量高于轻-中型组,差异均有统计学意义(P0.05)。(4)两组肺感染发生率、住院时间、出院3个月GOS评分比较,差异均有统计学意义(P0.05);其中重-特重型组患者较轻-中型组住院时间延长,肺感染发生率升高,GOS评分降低,差异均有统计学意义(P0.05)。结论 (1)血浆COR检测可作为CT检查必要有益的补充,TC、CBG、FC及FCI能够作为评估患者病情及出血的可靠指标。(2)自发性脑出血患者血浆皮质醇含量呈现24 h内升高达高峰,之后逐渐下降,在发病10 d左右降至正常水平的规律。发病后期出现的低皮质醇含量变化直接影响到患者的预后,后期皮质醇低于正常者其预后更差。(3)血浆COR水平的高低与患者发生肺感染有很密切的关系,同时也影响着患者的预后。
[Abstract]:Objective to detect plasma cortisol levels in patients with spontaneous cerebral hemorrhage at different time points and to understand the relationship between cortisol levels and disease development and prognosis, so as to provide theoretical basis for clinical treatment. Methods 45 patients with spontaneous cerebral hemorrhage were divided into two groups according to GCS score: mild to moderate group and severe to severe group, including 32 cases in mild to moderate group and 13 cases in severe group. On the 1st, 3rd, 7th, 10th and 14th day after onset, the contents of cortisol (COR), cortisol (TC), cortisol binding globulin (CBG) were measured in venous blood of patients, respectively. FC and FCI were calculated by TC and CBG values. Results (1) Plasma ACTH,COR in severe group and mild to moderate group increased at the 1st, 7th, 10th and 14th day of spontaneous cerebral hemorrhage, reached the peak within the first day, and then decreased gradually with time, and there was significant difference between the two groups (P0.05, P01). The plasma COR and ACTH levels in the severe group were significantly lower than those in the mild to moderate group, and there was a good correlation between the levels of COR and ACTH. (2) the FCI of TC,FC increased significantly on the first day after onset (P01), and then decreased gradually. The TC level in the mild to moderate group decreased to the normal reference range about the 10th day after onset, while that in the severe group was also higher than that in the normal reference range. There was no significant difference in CBG between mild to moderate group and severe to severe group on the first day after onset (P 0.05), but gradually increased and statistically significant (P 0.01). (3). There were significant differences in GCS score, Graeb score and blood loss between the two groups on admission (P 0.05). Among them, the GCS score of severe and severe group was lower than that of mild to moderate group, and the Graeb score and bleeding volume were higher than those of mild to medium group. The difference was statistically significant (P 0.05). (4). The incidence of lung infection, hospitalization time and GOS score at 3 months after discharge were significantly different between the two groups (P 0.05). Among them, the hospitalization time was prolonged, the incidence of lung infection was increased and the GOS score was decreased in the mild to moderate group, the difference was statistically significant (P 0.05). Conclusion (1) the detection of plasma COR can be used as a necessary supplement to CT, and TC,CBG,FC and FCI can be used as a reliable index to evaluate the condition and bleeding of patients. (2) the content of plasma cortisol in patients with spontaneous cerebral hemorrhage increased to the peak within 24 hours, then decreased gradually, and decreased to normal level about 10 days after onset. The changes of low cortisol content in the late stage of the disease directly affect the prognosis of the patients, and the prognosis of the patients with cortisol is lower than that of the normal group at the later stage. (3) the level of plasma COR is closely related to the occurrence of pulmonary infection, and also affects the prognosis of the patients.
【作者单位】：扬州市职业大学医学院;苏州大学附属高邮市人民医院神经外科;苏州大学附属高邮市人民医院检验科;
【分类号】：R743.34

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