1 Department of Trauma and Hand Surgery, Faculty of Medicine, Faculty of Medicine, University of Debrecen , Debrecen, Hungary .
2 Division of Endocrinology, Department of Medicine, Faculty of Medicine, Faculty of Medicine, University of Debrecen , Debrecen, Hungary .
J Neurotrauma. 2017 Dec 1;34(23):3238-3244. doi: 10.1089/neu.2017.5198. Epub 2017 Nov 1.
More than 80% of traumatic brain injury (TBI) patients suffer from mild TBI (mTBI). However, even mTBI carries the risk of late pituitary dysfunction. A predictive biomarker at the time of injury that could identify patients who subsequently may develop permanent pituitary dysfunction would help to direct patients toward endocrine care. We enrolled 508 TBI patients (406 with mTBI) into our study. Blood samples were collected for identification of predictive biomarkers of late pituitary dysfunction at the time of admission. Follow-up blood samples were collected between 6 and 12 months after the TBI and were evaluated for pituitary function. Of the 406 mTBI patients, 76 were available for follow-up. Pre-existing mild pituitary dysfunction was found for 15 patients based on hormone levels at the time of injury. Of the remaining 61 patients, 10 have shown deficiency in at least one pituitary hormone: 4 had growth hormone deficiency, 3 gonadotropin, 2 thyrotropin, and 1 patient combined gonadotropin and thyrotropin deficiency. Hence, newly developed pituitary hormone deficiency was found in 16% of mTBI patients. Neither the cause of mTBI nor its complications were predictive of late pituitary dysfunction. Of the hemostasis parameters studied, lower plasminogen activator inhibitor type 1 (PAI-1) level at the time of injury was found to be predictive for the development of late pituitary dysfunction; sensitivity, specificity, and positive and negative predictive values were 80%, 67%, 32%, and 94%, respectively. Even mTBI carries a substantial risk of endocrine consequences. Serum PAI-1 level at the time of TBI may serve as a predictive biomarker of late pituitary dysfunction in mTBI patients.
超过 80%的创伤性脑损伤 (TBI) 患者患有轻度创伤性脑损伤 (mTBI)。然而，即使是 mTBI 也有发生迟发性垂体功能障碍的风险。在受伤时能预测随后可能发生永久性垂体功能障碍的生物标志物，将有助于指导患者进行内分泌治疗。我们招募了 508 名 TBI 患者（406 名患有 mTBI）参加我们的研究。在入院时采集血液样本，以确定迟发性垂体功能障碍的预测生物标志物。在 TBI 后 6 至 12 个月采集随访血液样本，并评估垂体功能。在 406 名 mTBI 患者中，有 76 名可进行随访。根据受伤时的激素水平，发现 15 名患者存在先前存在的轻度垂体功能障碍。在其余 61 名患者中，有 10 名至少有一种垂体激素缺乏：4 名生长激素缺乏，3 名促性腺激素缺乏，2 名促甲状腺激素缺乏，1 名患者同时存在促性腺激素和促甲状腺激素缺乏。因此，在 16%的 mTBI 患者中发现了新的垂体激素缺乏。mTBI 的病因及其并发症均不能预测迟发性垂体功能障碍。在所研究的止血参数中，受伤时纤溶酶原激活物抑制剂 1（PAI-1）水平较低与迟发性垂体功能障碍的发生有关；其灵敏度、特异性、阳性预测值和阴性预测值分别为 80%、67%、32%和 94%。即使是 mTBI 也会带来很大的内分泌后果。TBI 时的血清 PAI-1 水平可能是 mTBI 患者迟发性垂体功能障碍的预测生物标志物。
