儿童重型颅脑损伤后垂体相关激素变化及亚低温治疗对其的影响
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- 英文论文题名：Relative Pituitary Hormone Change in Children Following Severe traumatic brain injury and The Effects of Mild Hypothermia Treatment
- 论文作者：朱建新 ; 肖以磊 ; 李丽 ; 于福华 ; 张树葆 ; 孙明 ; 赵青菊 ; Li Gang
- 英文论文作者：Zhu Jianxin ; Xiao Yilei ; Li Li ; Yu Fuhua ; Zhang Shubao ; Sun Ming ; Zhao Qingju ; Li Gang ; Department of Neurosurgery ; Liaocheng Brain Hospital ; Department of Neurosurgery ; Qilu Hospital of Shandong University
- 年：2016
- 作者机构：山东省聊城市脑科医院神经外科;Department of Neurosurgery,Qilu Hospital of Shandong University;
- 论文关键词：重型颅脑损伤 ; 垂体相关激素 ; 亚低温 ; 儿童
- 英文论文关键词：severe traumatic brain injury ; relative pituitary hormone ; mild hypothermia ; child
- 会议召开时间：2016-12-01
- 会议录名称：中国医师进修论文选编
- 语种：中文
- 分类号：R726.5
- 学会代码：BCLK
- 会议名称：2016年12月中国医师进修学术交流会
- 会议地点：中国北京
- 主办单位：中国医师进修编委会
- 学会名称：百川利康（北京）国际医学研究院
- 页数：6
- 文件大小：690k
- 原文格式：D
- 会议级别：全国
摘要
目的:研究儿童重型颅脑损伤后垂体相关激素分泌变化,探讨亚低温治疗对垂体功能近、远期的影响。方法:103例儿童重型颅脑损伤患者伤后24小时内行内分泌功能检查,出现垂体相关激素分泌紊乱的83例患者随机分为常规治疗组(对照组)41例及亚低温治疗组42例。监测入院后第1、3、5、7、14天的生长激素、(GH)、泌乳素(PRL)、促肾上腺激素(ACTH)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平并分析动态变化趋势。伤后6个月随访垂体功能。结果:83例(80.58%)患者出现垂体相关激素分泌紊乱,单项激素紊乱31例(30.10%),两项以上紊乱52例(50.48%),出现分泌紊乱的前三位激素分别为PRL、ACTH、GH。亚低温治疗组患者的ACTH、PRL、FT3波动振幅明显低于对照组,GH、PRL、ACTH、FT3恢复至正常水平所需时间较对照组显著缩短。6个月后,亚低温治疗组患者垂体功能低下发生率16.67%,明显低于对照组的46.88%(P<0.01)。出现水平低下的前三位激素依次为GH、TSH、FT4。结论:儿童重型颅脑损伤后有较高的垂体功能异常发生率,亚低温治疗可有效改善早期垂体相关激素分泌紊乱程度,降低后期垂体功能低下发生率。
Objective: to observe the change of relative pituitary hormone in children after severe traumatic brain injury and to explore the short- and long-time effects of mild hypothermia on pituitary function.Methods: 103 children with severe traumatic brain injury were selected and endocrine function check was carried out with 24 h after injury. 83 patients with pituitary hormone disorder were divided randomly into 41 in normal treatment group(control group) and 42 in mild hypothermia group(treatment group). At days 1, 3, 5, 7, 14 after admission, the levels and change pattern of the following were examined: growth hormone(GH), prolactin(PRL), adrenocorticotropic hormone(ACTH), free triiodothyronine(FT3), free thyroxine(FT4), thyroid stimulating hormone(TSH). At month 6 after injury patients were visited to examine pituitary function. Results: Pituitary hormone disorder was found in 83 cases(80.58%).31 cases(30.10%) had disorder in single hormone, 52 cases(50.48%) in two or more hormones. The top three hormones with disorder were PRL, ACTH, and GH. The fluctuation of ACTH, PRL, FT3 in treatment group was obviously lower than control group. GH, PRL, ACTH, FT3 of treatment group returned to normal level within shorter time than control group. At month 6, patients in treatment group had a rate of 16.67% in pituitary function decrease, which was obviously lower than control group(P<0.01). The three hormones with lowest occurrence were GH, TSH, FT4. Conclusion: Children with severe traumatic brain injury have a high occurrence rate of pituitary dysfunction. Mild hypothermia treatment can reduce early-stage secretion disorder of pituitary hormones, and decrease the occurrence rate of later pituitary dysfunction.
Objective: to observe the change of relative pituitary hormone in children after severe traumatic brain injury and to explore the short- and long-time effects of mild hypothermia on pituitary function.Methods: 103 children with severe traumatic brain injury were selected and endocrine function check was carried out with 24 h after injury. 83 patients with pituitary hormone disorder were divided randomly into 41 in normal treatment group(control group) and 42 in mild hypothermia group(treatment group). At days 1, 3, 5, 7, 14 after admission, the levels and change pattern of the following were examined: growth hormone(GH), prolactin(PRL), adrenocorticotropic hormone(ACTH), free triiodothyronine(FT3), free thyroxine(FT4), thyroid stimulating hormone(TSH). At month 6 after injury patients were visited to examine pituitary function. Results: Pituitary hormone disorder was found in 83 cases(80.58%).31 cases(30.10%) had disorder in single hormone, 52 cases(50.48%) in two or more hormones. The top three hormones with disorder were PRL, ACTH, and GH. The fluctuation of ACTH, PRL, FT3 in treatment group was obviously lower than control group. GH, PRL, ACTH, FT3 of treatment group returned to normal level within shorter time than control group. At month 6, patients in treatment group had a rate of 16.67% in pituitary function decrease, which was obviously lower than control group(P<0.01). The three hormones with lowest occurrence were GH, TSH, FT4. Conclusion: Children with severe traumatic brain injury have a high occurrence rate of pituitary dysfunction. Mild hypothermia treatment can reduce early-stage secretion disorder of pituitary hormones, and decrease the occurrence rate of later pituitary dysfunction.
引文
[1]Rothman MS,Arciniegas DB,Filley CM,et al.The neuroen?docrine effects of traumatic brain injury.JNeuropsychiatry Clin Neurosci,2007,19(4):363-372.
[2]Baker AJ,Park E,Hare GM,et a1.Efects of resuscitation fluid on neurologic physiology after cerebral traunla and hemorrhage.J Trauma,2O08,64(2):348-35 7.
[3]Powner DJ,Boccalandro C,Alp MS,et a1.Endocrine failure after traumatic brain injury in adults.Neurocrit Care,2006,5(1):61-70.
[4]Bondanelli M,Ambrosio MR,Zatelli MC,et al.Hypopituitarism after traumatic brain injury[J].Eur JEndocrinol,2005,152(5):679-691.
[5]Reuters VS,Almeida Cde P,Teixeira Pde F,et a1.Effects of subclinical hypothyroidism treatment on psychiatric symptoms,muscular complaints and quality oflife.Arq Bras Endocrinol Metabol,2012,56:128-136.
[6]Tanriverdi F,Senyurek H,Unluhizarci K.High risk of hypopituitarism after traumatic brain injury,a prospective investigation of an terior pituitary function in the acute phase an d at 12-months after the trauma.J Clin Endocrinol Metab,2006,91(6):2105-2111.
[7]Agha A,Thompson CJ.Anterior pituitary dysfunction following traumatic brain injury.Clin Endoerinol,2006,64(5):481.488.
[8]Schneider H J,Stalla G K,Buchfelder M,et a1.Hypopituitarism after traumatic brain injury and subarachnoid haemorrhage.JAMA.2006,148(4):449-456.
[9]Rothman MS,Arciniegas DB,Filley CM,et a1.The Neuroendocrine Efects of Traumatic Brain Injury.JNeuropsychiatry Clin Neurosci,2007,19(4):363-372.
[10]Ahmed 1M,Kannappan H,Datta-Chaudhuri M,et a1.Hy。popituitarism due to pituitary macmadenoma in an older person:An unusual presentation.J Am Geriatr Soc,2008,56(1):172-173。
[11]Baxter D,Sharp D J,Feeney C,et al.Pituitary dysfunction after blast traumatic brain injury:The UK BIOSAP study.Annals of neurology,2013,74(4):527-36.
[12]Agha A,Rogers B,Sherlock M,et al.Anterior pituitary dysfunction in survivors of traumatic brain injury.J Clin Endocrinol Metab,2004,89(23):4929-4936.
[13]Auble BA,Bollepalli S,Makorof K,et a1.Hypopituitarism in pediatric survivors of inflicted traumatic brain injury.JNeurotrauma,2014,31(4):321-326.
[14]Jiang,J.Y.,Zhu,C.,and Yu,M.K.Effect of long-term mild hypothermia on patients with severe traumatic brain injury.1 year follow up of 87 cases.J.Neurosurg.2000.93:546-549.
[15]Kochanek,P.M.,and Safar,P.J.Therapeutic hypothermiafor severe traumatic brain injury.JAMA.2003.289:3007-3009.
[16]Adelson PD.Hypothermia following Pediatric Traumatic Brain Injury.Journal Of Neurotrauma.2009.26:429-436.
[17]Adelson PD,Ragheb J,Muizelaar JP,et al.PhaseⅡClinical Trial Of Moderate Hypothermia After Severe Traumatic Brain Injury In Children.Neurosurgery 2005.56:740-754.
[18]Zhi,D.S.,Zhang,S.,and Lin,X.Study on therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury.Surg.Neurol.2003.59:381-385.
[19]Takala RS,Katila AJ,Sonninen P,et a1.Panhypopituitarism after traumatic head injury.Neurocritical Care,2006,4(1):21-24.
[20]Klose MC,Juul A,Poulsgaard L,et a1.Pituitary insuficiency following head trauma.Ugeskr Laeger,2007,169:211-213.
[21]Schneider HJ,Schneider M,Rosen FV,et a1.Pituitary insuficiency following head injury-how common is it,and what is to be done?MMW Fortschr Med,2004.146(41):43-44.
[22]Bondan elli M,Am brosio MR,Zatelli MC,et al.Hypopituitarism after traumatic brain injury.Eur J Endocrinol,2005,152(5):679-691.
[23]Nakamura K,Ichinose T,Kaw akami T,et al.Traumatic panhypopituitarism:case report.No Shinkei Geka,2006,34(5):491-495.
[2]Baker AJ,Park E,Hare GM,et a1.Efects of resuscitation fluid on neurologic physiology after cerebral traunla and hemorrhage.J Trauma,2O08,64(2):348-35 7.
[3]Powner DJ,Boccalandro C,Alp MS,et a1.Endocrine failure after traumatic brain injury in adults.Neurocrit Care,2006,5(1):61-70.
[4]Bondanelli M,Ambrosio MR,Zatelli MC,et al.Hypopituitarism after traumatic brain injury[J].Eur JEndocrinol,2005,152(5):679-691.
[5]Reuters VS,Almeida Cde P,Teixeira Pde F,et a1.Effects of subclinical hypothyroidism treatment on psychiatric symptoms,muscular complaints and quality oflife.Arq Bras Endocrinol Metabol,2012,56:128-136.
[6]Tanriverdi F,Senyurek H,Unluhizarci K.High risk of hypopituitarism after traumatic brain injury,a prospective investigation of an terior pituitary function in the acute phase an d at 12-months after the trauma.J Clin Endocrinol Metab,2006,91(6):2105-2111.
[7]Agha A,Thompson CJ.Anterior pituitary dysfunction following traumatic brain injury.Clin Endoerinol,2006,64(5):481.488.
[8]Schneider H J,Stalla G K,Buchfelder M,et a1.Hypopituitarism after traumatic brain injury and subarachnoid haemorrhage.JAMA.2006,148(4):449-456.
[9]Rothman MS,Arciniegas DB,Filley CM,et a1.The Neuroendocrine Efects of Traumatic Brain Injury.JNeuropsychiatry Clin Neurosci,2007,19(4):363-372.
[10]Ahmed 1M,Kannappan H,Datta-Chaudhuri M,et a1.Hy。popituitarism due to pituitary macmadenoma in an older person:An unusual presentation.J Am Geriatr Soc,2008,56(1):172-173。
[11]Baxter D,Sharp D J,Feeney C,et al.Pituitary dysfunction after blast traumatic brain injury:The UK BIOSAP study.Annals of neurology,2013,74(4):527-36.
[12]Agha A,Rogers B,Sherlock M,et al.Anterior pituitary dysfunction in survivors of traumatic brain injury.J Clin Endocrinol Metab,2004,89(23):4929-4936.
[13]Auble BA,Bollepalli S,Makorof K,et a1.Hypopituitarism in pediatric survivors of inflicted traumatic brain injury.JNeurotrauma,2014,31(4):321-326.
[14]Jiang,J.Y.,Zhu,C.,and Yu,M.K.Effect of long-term mild hypothermia on patients with severe traumatic brain injury.1 year follow up of 87 cases.J.Neurosurg.2000.93:546-549.
[15]Kochanek,P.M.,and Safar,P.J.Therapeutic hypothermiafor severe traumatic brain injury.JAMA.2003.289:3007-3009.
[16]Adelson PD.Hypothermia following Pediatric Traumatic Brain Injury.Journal Of Neurotrauma.2009.26:429-436.
[17]Adelson PD,Ragheb J,Muizelaar JP,et al.PhaseⅡClinical Trial Of Moderate Hypothermia After Severe Traumatic Brain Injury In Children.Neurosurgery 2005.56:740-754.
[18]Zhi,D.S.,Zhang,S.,and Lin,X.Study on therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury.Surg.Neurol.2003.59:381-385.
[19]Takala RS,Katila AJ,Sonninen P,et a1.Panhypopituitarism after traumatic head injury.Neurocritical Care,2006,4(1):21-24.
[20]Klose MC,Juul A,Poulsgaard L,et a1.Pituitary insuficiency following head trauma.Ugeskr Laeger,2007,169:211-213.
[21]Schneider HJ,Schneider M,Rosen FV,et a1.Pituitary insuficiency following head injury-how common is it,and what is to be done?MMW Fortschr Med,2004.146(41):43-44.
[22]Bondan elli M,Am brosio MR,Zatelli MC,et al.Hypopituitarism after traumatic brain injury.Eur J Endocrinol,2005,152(5):679-691.
[23]Nakamura K,Ichinose T,Kaw akami T,et al.Traumatic panhypopituitarism:case report.No Shinkei Geka,2006,34(5):491-495.
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