中华神经医学杂志
中華神經醫學雜誌
중화신경의학잡지
CHINESE JOURNAL OF NEUROMEDICINE
2015年
6期
614-618
,共5页
梁观钦%潘军%漆松涛%陆云涛
樑觀欽%潘軍%漆鬆濤%陸雲濤
량관흠%반군%칠송도%륙운도
颅脑损伤%中远期%垂体激素%临床因素
顱腦損傷%中遠期%垂體激素%臨床因素
로뇌손상%중원기%수체격소%림상인소
Traumatic brain injury%Mid-long term%Pituitary hormone%Clinical factors
目的 探讨重型颅脑损伤中远期垂体激素变化的特点及临床影响因素. 方法 选择南方医院神经外科自2011年1月至2013年12月收治的79例重度颅脑损伤患者,在伤后6个月～2年回访检测垂体激素及皮质醇、睾酮、雌二醇、游离甲状腺素的基础水平,分析垂体激素异常改变的发生率及激素类型特点,采用单因素分析及多因素Logistic回归分析探讨影响重型颅脑损伤中远期垂体激素异常改变的相关临床因素. 结果 79例重度颅脑损伤患者中35例发生垂体激素异常改变,发生率为44.30％;激素类型主要包括催乳素(PRL) 18例(26.87％)、甲状腺激素(TSH)16例(23.88％)、促肾上腺皮质激素(ACTH)9例(13.43％)、生长激素(GH)8例(11.94％)、卵泡刺激素(FSH)10例(14.93％)、黄体生成素(LH)6例(8.96％).多因素Logistic回归分析显示,重型颅脑损伤后中远期垂体激素异常改变的相关临床因素包括弥漫性损伤(OR=5.252,95％CI:1.176～23.465,P=0.030)、脑疝(OR=4.119,95％CI:1.261～13.452,P=0.019)、蛛网膜下腔出血(OR=3.966,95％CI:1.179～13.337,P=0.026)及颅底骨折(OR=4.222,95％CI:1.087～16.396,P=0.037). 结论 重型颅脑损伤中远期易并发垂体激素异常改变,弥漫性损伤、脑疝、蛛网膜下腔出血及颅底骨折是其高危因素.
目的 探討重型顱腦損傷中遠期垂體激素變化的特點及臨床影響因素. 方法 選擇南方醫院神經外科自2011年1月至2013年12月收治的79例重度顱腦損傷患者,在傷後6箇月～2年迴訪檢測垂體激素及皮質醇、睪酮、雌二醇、遊離甲狀腺素的基礎水平,分析垂體激素異常改變的髮生率及激素類型特點,採用單因素分析及多因素Logistic迴歸分析探討影響重型顱腦損傷中遠期垂體激素異常改變的相關臨床因素. 結果 79例重度顱腦損傷患者中35例髮生垂體激素異常改變,髮生率為44.30％;激素類型主要包括催乳素(PRL) 18例(26.87％)、甲狀腺激素(TSH)16例(23.88％)、促腎上腺皮質激素(ACTH)9例(13.43％)、生長激素(GH)8例(11.94％)、卵泡刺激素(FSH)10例(14.93％)、黃體生成素(LH)6例(8.96％).多因素Logistic迴歸分析顯示,重型顱腦損傷後中遠期垂體激素異常改變的相關臨床因素包括瀰漫性損傷(OR=5.252,95％CI:1.176～23.465,P=0.030)、腦疝(OR=4.119,95％CI:1.261～13.452,P=0.019)、蛛網膜下腔齣血(OR=3.966,95％CI:1.179～13.337,P=0.026)及顱底骨摺(OR=4.222,95％CI:1.087～16.396,P=0.037). 結論 重型顱腦損傷中遠期易併髮垂體激素異常改變,瀰漫性損傷、腦疝、蛛網膜下腔齣血及顱底骨摺是其高危因素.
목적 탐토중형로뇌손상중원기수체격소변화적특점급림상영향인소. 방법 선택남방의원신경외과자2011년1월지2013년12월수치적79례중도로뇌손상환자,재상후6개월～2년회방검측수체격소급피질순、고동、자이순、유리갑상선소적기출수평,분석수체격소이상개변적발생솔급격소류형특점,채용단인소분석급다인소Logistic회귀분석탐토영향중형로뇌손상중원기수체격소이상개변적상관림상인소. 결과 79례중도로뇌손상환자중35례발생수체격소이상개변,발생솔위44.30％;격소류형주요포괄최유소(PRL) 18례(26.87％)、갑상선격소(TSH)16례(23.88％)、촉신상선피질격소(ACTH)9례(13.43％)、생장격소(GH)8례(11.94％)、란포자격소(FSH)10례(14.93％)、황체생성소(LH)6례(8.96％).다인소Logistic회귀분석현시,중형로뇌손상후중원기수체격소이상개변적상관림상인소포괄미만성손상(OR=5.252,95％CI:1.176～23.465,P=0.030)、뇌산(OR=4.119,95％CI:1.261～13.452,P=0.019)、주망막하강출혈(OR=3.966,95％CI:1.179～13.337,P=0.026)급로저골절(OR=4.222,95％CI:1.087～16.396,P=0.037). 결론 중형로뇌손상중원기역병발수체격소이상개변,미만성손상、뇌산、주망막하강출혈급로저골절시기고위인소.
Objective To investigate the characteristics of mid-long term pituitary hormone abnormalities in patients after severe traumatic brain injury (TBI) and its influencing clinical factors.Methods A total of 79 patients with severe TBI,admitted to our hospital from January 2011 to December 2013,were chosen in our research.Their basal levels of pituitary hormones,cortisol,testosterone,estradiol and free thyroxine 4 were detected in 6 months to 2 years after injury;and their clinical data were retrospectively analyzed by Chi-square test and multivariate Logistic regression analysis was employed to explore the incidence and types of pituitary hormone abnormalities,and the possible influencing factors.Results There were 35 patients with pituitary hormone abnormalities in 79 patients,with an incidence of 44.30％;the types of pituitary hormone abnormalities included prolactin in 18 patients (26.87％),thyroid stimulating hormone in 16 patients (23.88％),adrenocorticotropic hormone in 9 (13.43％),growth hormone in 8 (11.94％),and follicle stimulating hormone in 10 (14.93％) and luteinizing hormone in 6 (8.96％).Multivariate Logistic regression analysis showed that factors associated with pituitary hormone abnormalities following severe TBI in the mid-long term were diffused injury (OR=5.252,95％CI:1.176-23.465,P=0.030),brain hernia (OR=4.119,95％CI:1.261-13.452,P=0.019),subarachnoid hemorrhage (OR=3.966,95％CI:1.179-13.337,P=-0.026) and skull fracture (OR=4.222,95％CI:1.087-16.396,P=0.037).Conclusion Pituitary hormones following severe TBI are likely to be abnormal,and diffused injury,brain hernia,subarachnoid hemorrhage and skull fracture are the risk factors.
