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目的探讨颅脑创伤慢性期垂体各型激素低下发病情况及替代治疗的效果。方法以120名颅脑创伤慢性后遗症患者作为研究对象,收集患者一般临床资料和CT影像学资料,并于伤后6个月和12个月分别测定患者垂体生长激素(GH)、促肾上腺皮质激素(ACTH)、促甲状腺激素(TSH)、促性腺激素(LH/FSH)缺乏和抗利尿激素(ADH),使用多因素Logistic回归分析颅脑创伤后垂体功能低下的影响因素。另外对垂体功能低下患者行GH替代治疗,评估替代治疗的疗效。结果伤后12个月患者GH、ACTH、TSH、LH/FSH和ADH缺乏发病率分别为19.2%、3.3%、0%、12.5%和1.7%,与伤后6个月比,患者GH缺乏发病率无明显改变,而其他激素缺乏均有一定程度恢复。垂体功能低下组BMI、缺氧比例、弥漫性脑肿胀比例、经手术清除的脑内血肿比例和头颅CT总分数均显著高于非垂体功能低下组。多因素Logistic回归分析显示BMI、缺氧、弥漫性脑肿胀和头颅CT总分数是颅脑创伤后垂体功能低下的独立危险因素。进一步行GH替代治疗发现,治疗后垂体功能低下组患者残疾程度评分显著优于治疗前(P<0.05)。结论颅脑创伤后GH和LH/FSH缺乏发生率高且持久,BMI、缺氧、弥漫性脑肿胀和头颅CT总分数是颅脑创伤后垂体功能低下的独立危险因素。GH替代治疗有利于垂体功能低下患者的恢复。
Objective To investigate the incidence of pituitary hypopituitarism and the effect of replacement therapy in patients with chronic traumatic brain injury. Methods A total of 120 patients with chronic sequelae of traumatic brain injury were enrolled in this study. The general clinical data and CT imaging data were collected. The changes of pituitary growth hormone (GH), adrenocorticotropic hormone (ACTH), thyrotropin (TSH), deficiency of gonadotropin (LH / FSH) and antidiuretic hormone (ADH). Logistic regression analysis was used to analyze the influencing factors of pituitary dysfunction after traumatic brain injury. In addition to hypoglycemic patients with GH replacement therapy to assess the efficacy of alternative therapies. Results The incidences of GH, ACTH, TSH, LH / FSH and ADH were 19.2%, 3.3%, 0%, 12.5% and 1.7% respectively at 12 months after injury. Compared with 6 months after injury, patients with GH deficiency No significant change in rates, and other hormone deficiencies have a certain degree of recovery. Pituitary dysfunction group BMI, hypoxia, diffuse brain swelling ratio, surgical removal of intracerebral hematoma and cranial CT total score were significantly higher than non-pituitary dysfunction group. Multivariate logistic regression analysis showed that BMI, hypoxia, diffuse brain swelling and total head CT score were independent risk factors for hypopituitarism after traumatic brain injury. Further GH replacement therapy found that after treatment, patients with pituitary dysfunction score was significantly better than before treatment disabled (P <0.05). Conclusions The incidence of GH and LH / FSH deficiency after traumatic brain injury is high and persistent. The BMI, hypoxia, diffuse brain swelling and total head CT score are independent risk factors for pituitary dysfunction after traumatic brain injury. GH replacement therapy is conducive to the recovery of patients with hypopituitarism.