Cernak I, Savic J, Lazarov A
Institute for Medical Research, Military Medical Academy, Crnotravska 17, 11000 Belgrade, Yugoslavia.
World J Surg. 1997 Mar-Apr;21(3):240-5; discussion 246. doi: 10.1007/s002689900223.
Tissue trauma leads to a complex hormonal response of pituitary end-organ axis. This response can be recorded by determining parameters that represent the functional integrity of these systems. The concentrations of serum prolactin (PRL), serum testosterone, and plasma adrenocorticotropin (ACTH) were measured in 62 adult male casualties from the recent war in former Yugoslavia. Patients with brain injury were not included. Venous blood samples were taken as soon as possible (2-18 hours) after admission and at 1, 2, 5, and 14 days after injury. The severity of gunshot/missile wounds was assessed by the Injury Severity Score (ISS). The control group consisted of healthy blood donors. Uninjured subjects who had undergone great stress on the battlefield (explosion in the vicinity without injury) served as the sham-control group. Tissue trauma leads to a severity-dependent decrease in serum testosterone concentrations during the first 5 days following injury. Significant correlations were observed between ACTH, prolactin, and ISS during the first 18 hours after injury. A strong negative correlation between testosterone and prolactin serum concentrations was found during the first 18 hours. In patients with additional complications or unsatisfactory outcome, the prolactin concentrations remained elevated, whereas testosterone concentrations were reduced. Our results support the usefulness of recording hormonal changes for determining trauma severity and monitoring the clinical course. Such monitoring also helps assess the efficacy of therapeutic strategies. The relation between testosterone and prolactin might be helpful for predicting the clinical course and trauma outcome.
组织创伤会导致垂体终末器官轴产生复杂的激素反应。这种反应可通过测定代表这些系统功能完整性的参数来记录。对62名来自前南斯拉夫近期战争的成年男性伤员测定了血清催乳素（PRL）、血清睾酮和血浆促肾上腺皮质激素（ACTH）的浓度。未纳入脑损伤患者。入院后尽快（2 - 18小时）以及伤后1、2、5和14天采集静脉血样。通过损伤严重程度评分（ISS）评估枪伤/导弹伤的严重程度。对照组由健康献血者组成。在战场上承受巨大压力（附近爆炸但未受伤）的未受伤受试者作为假对照组。组织创伤导致伤后前5天血清睾酮浓度随严重程度下降。伤后前18小时观察到ACTH、催乳素与ISS之间存在显著相关性。伤后前18小时发现睾酮与血清催乳素浓度之间存在强烈负相关。在有其他并发症或预后不佳的患者中，催乳素浓度持续升高，而睾酮浓度降低。我们的结果支持记录激素变化对于确定创伤严重程度和监测临床病程的有用性。这种监测也有助于评估治疗策略的疗效。睾酮与催乳素之间的关系可能有助于预测临床病程和创伤结局。
