早期内分泌改变反映了长期应激，且与重型脑损伤患者的1年功能预后相关。
Early endocrine alterations reflect prolonged stress and relate to 1-year functional outcome in patients with severe brain injury.
作者信息
Marina Djordje, Klose Marianne, Nordenbo Annette, Liebach Annette, Feldt-Rasmussen Ulla
机构信息
Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark.
Department of Medical Endocrinology PE2131Rigshospital, Copenhagen University Hospital, Copenhagen, DenmarkTraumatic Brain Injury UnitDepartment of Neurorehabilitation, Glostrup Hospital, Copenhagen University Hospital, Glostrup, Denmark
出版信息
Eur J Endocrinol. 2015 Jun;172(6):813-22. doi: 10.1530/EJE-14-1152. Epub 2015 Mar 30.
OBJECTIVE
Severe brain injury may increase the risk of developing acute and chronic hypopituitarism. Pituitary hormone alterations developed in the early recovery phase after brain injury may have implications for long-term functional recovery. The objective of the present study was to assess the pattern and prevalence of pituitary hormone alterations 3 months after a severe brain injury with relation to functional outcome at a 1-year follow-up.
DESIGN
Prospective study at a tertiary university referral centre.
METHODS
A total of 163 patients admitted to neurorehabilitation after severe traumatic brain injury (TBI, n=111) or non-TBI (n=52) were included. The main outcome measures were endocrine alterations 3.3 months (median) after the brain injury and their relationship to the functioning and ability of the patients at a 1-year follow-up, as measured by the Functional Independence Measure and the Glasgow Outcome Scale-Extended.
RESULTS
Three months after the injury, elevated stress hormones (i.e. 30 min stimulated cortisol, prolactin and/or IGF1) and/or suppressed gonadal or thyroid hormones were recorded in 68 and 32% of the patients respectively. At 1 year after the injury, lower functioning level (Functional Independence Measure) and lower capability of performing normal life activities (Glasgow Outcome Scale-Extended) were related to both the elevated stress hormones (P≤0.01) and the reduced gonadal and/or thyroid hormones (P≤0.01) measured at 3 months.
CONCLUSION
The present study suggests that brain injury-related endocrine alterations that mimic secondary hypogonadism and hypothyroidism and that occur with elevated stress hormones most probably reflect a prolonged stress response 2-5 months after severe brain injury, rather than pituitary insufficiency per se. These endocrine alterations thus seem to reflect a more severe disease state and relate to 1-year functional outcome.
目的
重度脑损伤可能增加发生急性和慢性垂体功能减退的风险。脑损伤后早期恢复阶段出现的垂体激素改变可能对长期功能恢复有影响。本研究的目的是评估重度脑损伤3个月后垂体激素改变的模式和患病率，并将其与1年随访时的功能结局相关联。
设计
在一所三级大学转诊中心进行的前瞻性研究。
方法
纳入163例重度创伤性脑损伤（TBI，n = 111）或非TBI（n = 52）后接受神经康复治疗的患者。主要结局指标为脑损伤后3.3个月（中位数）的内分泌改变及其与患者1年随访时功能和能力的关系，通过功能独立性测量和扩展格拉斯哥结局量表进行评估。
结果
损伤后3个月，分别有68%和32%的患者记录到应激激素升高（即30分钟刺激后的皮质醇、催乳素和/或IGF1）和/或性腺或甲状腺激素抑制。损伤后1年，较低的功能水平（功能独立性测量）和较低的正常生活活动能力（扩展格拉斯哥结局量表）与3个月时测量的应激激素升高（P≤0.01）以及性腺和/或甲状腺激素降低（P≤0.01）均相关。
结论
本研究表明，与脑损伤相关的内分泌改变模拟继发性性腺功能减退和甲状腺功能减退，并伴有应激激素升高，很可能反映了重度脑损伤后2 - 5个月的长期应激反应，而非垂体功能不全本身。因此，这些内分泌改变似乎反映了更严重的疾病状态，并与1年的功能结局相关。
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