本文選題：創(chuàng)傷性顱腦損傷 + 垂體前葉激素��； 參考：《皖南醫(yī)學(xué)院》2017年碩士論文

【摘要】：目的:通過測(cè)定創(chuàng)傷性顱腦損傷(traumatic brain injury,TBI)患者在受傷后不同時(shí)間點(diǎn)的血清中促甲狀腺激素(TSH)、生長激素(GH)、卵泡刺激素(FSH)、泌乳素(PRL)、促腎上腺皮質(zhì)激素(ACTH)的含量,探討分析垂體前葉相關(guān)激素的變化以及與患者傷情嚴(yán)重程度和預(yù)后之間的相互關(guān)系。為TBI患者傷后垂體前葉相關(guān)激素異常的臨床診斷和相關(guān)激素替代治療提供更多的理論支持。方法:選取皖南醫(yī)學(xué)院附屬弋磯山醫(yī)院神經(jīng)外科2015年10月至2016.10月期間收住入院的TBI患者病例資料,并依據(jù)納入標(biāo)準(zhǔn)和排除標(biāo)準(zhǔn),選取其中符合條件的128例病例資料,根據(jù)患者入院時(shí)的病情嚴(yán)重程度并依據(jù)格拉斯哥昏迷評(píng)分標(biāo)準(zhǔn)(Glasgow coma scale,GCS)分組:參照GCS分?jǐn)?shù),13到15分評(píng)為輕度,共36例,9到12分評(píng)為中度,共44例,6到8分評(píng)為重度,共26例,3到5分為特重度,共22例;通過分別測(cè)定其在受傷后第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,動(dòng)態(tài)監(jiān)測(cè)TBI患者在受傷后不同時(shí)間點(diǎn)的激素含量改變,并分析與患者病情和以后預(yù)后轉(zhuǎn)歸之間的相關(guān)關(guān)系。另外從本院體檢中心選取40例既往無相關(guān)內(nèi)分泌系統(tǒng)疾病病史的健康體檢者作為本次研究的對(duì)照組。結(jié)果:本次研究中對(duì)所有TBI患者在受傷后不同時(shí)間點(diǎn)(第1、3、7、14天)內(nèi)進(jìn)行各個(gè)激素含量的檢測(cè),GH、FSH以及ACTH異常的發(fā)生率最高,而TSH和PRL在傷后異常的發(fā)生率相對(duì)較低;GH、TSH、ACTH、FSH、PRL含量在傷后均出現(xiàn)升高,主要集中在前三天,尤其GH、ACTH和FSH,變化更是明顯,第1、3天含量明顯高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義,一周后所有激素均開始逐漸恢復(fù);輕中度患者在傷后各個(gè)激素均有所升高,但總體幅度不大,重度和特重度TBI患者在傷后的激素含量增長幅度大,比對(duì)照組高出很多,差別有統(tǒng)計(jì)學(xué)意義;預(yù)后不良組患者的激素含量與預(yù)后良好組相比,預(yù)后不良組患者GH在第1、2天的含量與預(yù)后良好組相比有統(tǒng)計(jì)學(xué)意義,TSH和PRL僅在受傷后第1天的含量與預(yù)后良好組相比有統(tǒng)計(jì)學(xué)意義,而ACTH在受傷后第1、3、7天的含量與預(yù)后良好組相比具有統(tǒng)計(jì)學(xué)意義,而FSH在受傷后第1、3、7、14的含量與預(yù)后良好組相比均有統(tǒng)計(jì)學(xué)意義。結(jié)論:(1)TBI患者在傷后垂體前葉分泌的相關(guān)激素含量會(huì)有異常,最常見的是GH、FSH以及ACTH的異常;(2)TBI患者傷后出現(xiàn)的激素異常主要在前三天,各激素含量變化最明顯,后逐漸開始恢復(fù);(3)輕度TBI患者的激素含量變化一般不是很明顯,無重要的臨床意義,重度和特重度TBI患者激素含量變化大,與病情本身嚴(yán)重程度呈密切相關(guān),有重要的臨床參考意義;(4)TBI患者傷后激素含量的改變對(duì)病人的預(yù)后評(píng)估有很重要的臨床價(jià)值,傷后第1、3天出現(xiàn)激素含量明顯的異常,多提示預(yù)后不理想,相反,激素含量變化幅度不大,呈現(xiàn)比較平穩(wěn)的狀態(tài),多提示預(yù)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.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651.15

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