Emelifeonwu John A, Flower Hannah, Loan Jamie J, McGivern Kieran, Andrews Peter J D
Department of Neurosurgery, University of Edinburgh and NHS Lothian Western General Hospital, Edinburgh, United Kingdom.
Center for Clinical Brain Sciences, University of Edinburgh and NHS Lothian Western General Hospital, Edinburgh, United Kingdom.
J Neurotrauma. 2020 Jan 15;37(2):217-226. doi: 10.1089/neu.2018.6349. Epub 2019 Oct 21.
The objective of this study is to systematically review clinical studies that have reported on the prevalence of chronic post-traumatic brain injury anterior pituitary dysfunction (PTPD) 12 months or more following traumatic brain injury (TBI). We searched Medline, Embase, and PubMed up to April 2017 and consulted bibliographies of narrative reviews. We included cohort, case-control, and cross-sectional studies enrolling at least five adults with primary TBI in whom at least one anterior pituitary axis was assessed at least 12 months following TBI. We excluded studies in which other brain injuries were indistinguishable from TBI. Study quality was assessed using the Newcastle-Ottawa Scale (NOS) score. We also considered studies that determined growth hormone deficiency and adrenocorticotrophic hormone reserve using provocation test to be at low risk of bias. Data were extracted by four independent reviewers and assessed for risk of bias using a data extraction form. We performed meta-analyses using random effect models and assessed heterogeneity using the index. We identified 58 publications, of which 29 (2756 participants) were selected for meta-analysis. Twelve of these were deemed to be at low risk of bias and therefore "high-quality," as they had NOS scores greater than 8 and had used provocation tests. The overall prevalence of at least one anterior pituitary hormone dysfunction for all 29 studies was 32% (95% confidence interval [CI] 25-38%). The overall prevalence in the 12 high-quality studies was 34% (95% CI 27-42%). We observed significant heterogeneity that was not solely explained by the risk of bias. Studies with a higher proportion of participants with mild TBI had a lower prevalence of PTPD. Our results show that approximately one-third of TBI sufferers have persistent anterior pituitary dysfunction 12 months or more following trauma. Future research on PTPD should differentiate between mild and moderate/severe TBI.
本研究的目的是系统回顾创伤性脑损伤（TBI）12个月或更长时间后慢性创伤后脑损伤垂体前叶功能障碍（PTPD）患病率的临床研究。我们检索了截至2017年4月的Medline、Embase和PubMed，并查阅了叙述性综述的参考文献。我们纳入了队列研究、病例对照研究和横断面研究，这些研究纳入了至少五名原发性TBI成年人，在TBI后至少12个月对至少一个垂体前叶轴进行了评估。我们排除了其他脑损伤与TBI无法区分的研究。使用纽卡斯尔-渥太华量表（NOS）评分评估研究质量。我们还认为使用激发试验确定生长激素缺乏和促肾上腺皮质激素储备的研究偏倚风险较低。数据由四名独立评审员提取，并使用数据提取表评估偏倚风险。我们使用随机效应模型进行荟萃分析，并使用I²指数评估异质性。我们识别出58篇出版物，其中29篇（2756名参与者）被选入荟萃分析。其中12篇被认为偏倚风险较低，因此是“高质量”的，因为它们的NOS评分大于8且使用了激发试验。所有29项研究中至少一种垂体前叶激素功能障碍的总体患病率为32%（95%置信区间[CI]25-38%）。12项高质量研究中的总体患病率为34%（95%CI 27-42%）。我们观察到显著的异质性，这不能仅由偏倚风险来解释。轻度TBI参与者比例较高的研究中PTPD的患病率较低。我们的结果表明，约三分之一的TBI患者在创伤后12个月或更长时间存在持续性垂体前叶功能障碍。未来关于PTPD的研究应区分轻度和中度/重度TBI。
