急性皮质醇谱与严重创伤性脑损伤后认知障碍的相关性。
Acute Cortisol Profile Associations With Cognitive Impairment After Severe Traumatic Brain Injury.
机构信息
Department of Emergency Medicine, 6614University of Pittsburgh, Pittsburgh, PA, USA.
Department of Physical Medicine & Rehabilitation, 6614University of Pittsburgh, Pittsburgh, PA, USA.
出版信息
Neurorehabil Neural Repair. 2021 Dec;35(12):1088-1099. doi: 10.1177/15459683211048771. Epub 2021 Oct 23.
BACKGROUND
Cognitive impairments commonly occur after traumatic brain injury (TBI) and affect daily functioning. Cortisol levels, which are elevated during acute hospitalization for most individuals after severe TBI, can influence cognition, but this association has not been studied previously in TBI.
OBJECTIVE
We hypothesized that serum and cerebral spinal fluid (CSF) cortisol trajectories over days 0-5 post-injury are associated with cognition 6-month post-injury.
METHODS
We examined 94 participants with severe TBI, collected acute serum and/or CSF samples over days 0-5 post-injury, and compared cortisol levels to those in 17 healthy controls. N = 88 participants had serum, and n = 84 had CSF samples available for cortisol measurement and had neuropsychological testing 6 months post-injury. Group based trajectory analysis (TRAJ) was used to generate temporal serum and CSF cortisol profiles which were examined for associations with neuropsychological performance. We used linear regression to examine relationships between cortisol TRAJ groups and both overall and domain-specific cognition.
RESULTS
TRAJ analysis identified a group and a group for serum and a group and group for CSF cortisol. Multivariable analysis showed serum cortisol TRAJ group was associated with overall cognitive composites scores ( = .024) and with executive function ( = .039) and verbal fluency ( = .029) domain scores. CSF cortisol TRAJ group was associated with overall cognitive composite scores ( = .021) and domain scores for executive function ( = .041), verbal fluency ( = .031), and attention ( = .034).
CONCLUSIONS
High acute cortisol trajectories are associated with poorer cognition 6 months post-TBI.
背景
颅脑损伤（TBI）后常出现认知障碍，影响日常功能。大多数严重 TBI 患者在急性住院期间皮质醇水平升高，皮质醇会影响认知，但之前在 TBI 中尚未对此相关性进行研究。
目的
我们假设损伤后 0-5 天的血清和脑脊液（CSF）皮质醇轨迹与损伤后 6 个月的认知功能相关。
方法
我们检查了 94 名严重 TBI 患者，在损伤后 0-5 天期间采集了急性血清和/或 CSF 样本，并将皮质醇水平与 17 名健康对照者进行了比较。N = 88 名参与者有血清样本，n = 84 名参与者有 CSF 样本可用于皮质醇测量，并在损伤后 6 个月进行了神经心理学测试。使用基于群组的轨迹分析（TRAJ）生成时间性血清和 CSF 皮质醇图谱，并对其与神经心理学表现的相关性进行了研究。我们使用线性回归来检查皮质醇 TRAJ 组与整体和特定领域认知之间的关系。
结果
TRAJ 分析确定了血清皮质醇的 组和 组，CSF 皮质醇的 组和 组。多变量分析显示，血清皮质醇 TRAJ 组与整体认知综合评分（ =.024）和执行功能（ =.039）和言语流畅性（ =.029）域评分相关。CSF 皮质醇 TRAJ 组与整体认知综合评分（ =.021）和执行功能（ =.041）、言语流畅性（ =.031）和注意力（ =.034）域评分相关。
结论
高急性皮质醇轨迹与 TBI 后 6 个月认知较差相关。
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