Kusmenkov T, Braunstein M, Schneider H J, Bidlingmaier M, Prall W C, Flatz W, Boecker W, Bogner V
1 Department of Trauma Surgery, Ludwig Maximilians University Munich, Munich, Germany.
2 Department of Internal Medicine IV: Endocrinology, Ludwig Maximilians University Munich, Munich, Germany.
J Int Med Res. 2019 Mar;47(3):1185-1194. doi: 10.1177/0300060518819603. Epub 2019 Jan 7.
To determine free and total cortisol serum concentrations in the first 24 h after trauma and to evaluate the influence of traumatic brain injury (TBI) on their dynamics.
This prospective cohort study enrolled patients who had experienced multiple trauma and were admitted to a level 1 trauma centre. The patients were divided in two groups based on the presence of TBI according to clinical and radiological findings. Blood was collected initially as well as at 12 h and 24 h after the traumatic injury. Total cortisol, corticosteroid binding globulin (CBG) and free cortisol levels were determined.
The study analysed data from 49 patients (36 males and 13 females) with a mean ± SD age of 45.0 ± 16.0 years. Of these, 36 presented with TBI and 13 had multiple injuries without TBI. Patients with TBI showed significantly lower concentrations of total cortisol and free cortisol compared with patients without TBI. Repeated measures analysis revealed different concentration dynamics in patients with TBI, with no increase in cortisol after trauma.
Multiple trauma patients with TBI are at risk of acute impaired cortisol secretion and show an attenuated stress response as early as 12 h after injury.
测定创伤后最初24小时血清游离皮质醇和总皮质醇浓度，并评估创伤性脑损伤（TBI）对其动态变化的影响。
这项前瞻性队列研究纳入了经历多发伤并入住一级创伤中心的患者。根据临床和影像学检查结果，将患者按是否存在TBI分为两组。在创伤后即刻、12小时和24小时采集血液样本，测定总皮质醇、皮质类固醇结合球蛋白（CBG）和游离皮质醇水平。
该研究分析了49例患者（36例男性和13例女性）的数据，平均年龄为45.0±16.0岁。其中，36例患有TBI，13例有多发伤但无TBI。与无TBI的患者相比，TBI患者的总皮质醇和游离皮质醇浓度显著降低。重复测量分析显示，TBI患者的皮质醇浓度动态变化不同，创伤后皮质醇无升高。
伴有TBI的多发伤患者存在急性皮质醇分泌受损的风险，并且在受伤后12小时就表现出应激反应减弱。
