CAJ | 학술논문

目的探讨颅脑损伤患儿垂体相关激素的变化及其临床意义.方法应用电化学发光法,对125例颅脑损伤患儿及20例健康儿童血清泌乳素(PRL)、皮质醇(PTC)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)、生长激素(GH)进行定量分析,并按照伤后时间、入院时Glasgow Coma Scale(GCS)评分及出院时Glasgow Outcome Scale (GOS)评分分组分析其激素变化特点,对随访满2年的58例患儿分析其激素的变化特点与日常生活活动的关系.结果颅脑外伤后血清PRL与对照组比较1、3、5d内显著升高(P=0.0000、0.0000、0.0067).伤后30 d内轻度组与中度组、轻度组与重度组及中度组与重度组之间比较差异有统计学意义(P ＜0.05);3 d内血浆PTC水平明显升高,轻度组与中度组、轻度组与重度组差异均有统计学意义(P均＜0.05);TSH、FT3、FT4伤后略降低,后逐渐回升;GH变化不显著.GCS评分较低者垂体相关激素变化幅度较大;恢复期随访部分患儿可有不同程度的FT3、FT4、TSH、GH下降.PRL在GOS评分4～5与GOS评分1～3患儿中比较差异有统计学意义(P =0.000 1).结论儿童颅脑损伤后垂体相关激素的变化与伤后时间、严重程度有关,PRL有助于判断预后.
목적 탐토로뇌손상환인수체상관격소적변화급기림상의의.방법 응용전화학발광법,대125례로뇌손상환인급20례건강인동혈청비유소(PRL)、피질순(PTC)、유리삼전갑상선원안산(FT3)、유리갑상선소(FT4)、촉갑상선소(TSH)、생장격소(GH)진행정량분석,병안조상후시간、입원시Glasgow Coma Scale(GCS)평분급출원시Glasgow Outcome Scale (GOS)평분분조분석기격소변화특점,대수방만2년적58례환인분석기격소적변화특점여일상생활활동적관계.결과 로뇌외상후혈청PRL여대조조비교1、3、5d내현저승고(P=0.0000、0.0000、0.0067).상후30 d내경도조여중도조、경도조여중도조급중도조여중도조지간비교차이유통계학의의(P ＜0.05);3 d내혈장PTC수평명현승고,경도조여중도조、경도조여중도조차이균유통계학의의(P균＜0.05);TSH、FT3、FT4상후략강저,후축점회승;GH변화불현저.GCS평분교저자수체상관격소변화폭도교대;회복기수방부분환인가유불동정도적FT3、FT4、TSH、GH하강.PRL재GOS평분4～5여GOS평분1～3환인중비교차이유통계학의의(P =0.000 1).결론 인동로뇌손상후수체상관격소적변화여상후시간、엄중정도유관,PRL유조우판단예후.
Objective To explore the dynamic changes and clinical significance of relative pituitary hormones in children after craniocerebral injury.Methods The quantitative analysis and dynamic observation were performed in 125 children after craniocerebral injury and 20 voluntary healthy children of relative pituitary hormones including serum prolactin(PRL),cortisol(PTC),three free triiodothyronine (FT3),free thyroxine (FT4),thyroid stimulating hormone (TSH),growth hormone (GH) by applying electrochemical luminescence method.Tbe hormone variational characteristics were analyzed according to posttraumatic time,Glasgow Coma Scale(GCS) scores on admission and Glasgow Outcome Scale (GOS) scores on discharge,and the relationship between hormone variational characteristics of 58 cases was followed up over 2 years and the activities of daily living (ADL) were also investigated.Results The serum PRL was significantly increased on the first,third and fifth day compared with the healthy control group (P =0.000 0,0.000 0,0.006 7),respectively.There was significant difference between mild,moderate and severe groups within 30 days after suffering from craniocerebral injury (P ＜ 0.05).PTC was heavily increased within 3 days,and significant difference existed among mild and moderate groups mild and severe groups (all P ＜ 0.05) ; TSH,FT3,FT4 decreased slightly after injury and gradually rose in later;GH change wasn't significant;and the larger variation of relative pituitary hormones was responsible for lower GCS scores;FT3,FT4,TSH,and GH decreased in different degrees,which were found in parts of children with craniocerebral injury,and the significant difference of serum PRL existed between GOS scores 4-5 and GOS scores 1-3 groups (P =0.000 1).Conclusions The changes of relative pituitary hormones were associated with the posttraumatic time and the severity of craniocerebral injury.The PRL in serum can aid in prediction of outcome for the children with craniocerebral injury.