目的 探讨重度颅脑创伤后垂体功能减退的发生现状及影响因素。方法 选取东莞市松山湖中心医院收治的200例重度颅脑创伤患者,依据患者是否发生垂体功能减退分为两组,即减退组(45例)和正常组(155例),调查并比较两组临床资料的差异性,对可能影响垂体功能的相关因素进行对比及logistics回归分析。结果 200例重度患者垂体功能减退发生率为22.50%,主要为甲状腺功能、肾上腺功能以及性腺功能。减退组患者格拉斯哥昏迷评分(GCS)<5分、颅内压≥20 mmHg、中线移位≥5 mm、脑疝、弥漫性脑水肿、颅底骨折、入住ICU时间>10 d、住院时间>28 d等发生率均高于正常组(P＜0.05)。经logistics回归分析,垂体功能减退的危险因素包括GCS评分<5分、颅内压≥20 mmHg、中线移位≥5 mm、颅底骨折、弥漫性脑水肿。将GCS评分<5分、颅内压≥20 mmHg、中线移位≥5 mm、颅底骨折、弥漫性脑水肿纳入受试者工作曲线(ROC)分析,表明各危险因素联合共同预测垂体功能减退的临床价值更高。结论 重度颅脑创伤后垂体功能减退发生风险与颅内压、颅底骨折、弥漫性脑水肿、GCS评分等因素密切相关,临床应高度重视,及时干预,确保患者生命安全。
Abstract
Objective To investigate the current status and influencing factors of pituitary dysfunction after severe craniocerebral trauma. Methods A total of 200 patients with severe craniocerebral trauma admitted to Songshanhu Central Hospital in Dongguan City were selected and divided into two groups according to whether the patients suffered from hypopituitarism (45 cases) and normal group (155 cases). The differences of clinical data between the two groups were investigated and compared, the related factors that might affect pituitary function were compared and Logistics regression analysis was conducted. Results The incidence of pituitary dysfunction in 200 severe patients was 22.50%, mainly thyroid function, adrenal function and gonadal function. The incidence of Glasgow Coma Scale (GCS) score<5, intracranial pressure ≥20 mmHg, midline displacement ≥5 mm, cerebral herniation, diffuse cerebral edema, skull base fracture, ICU stay>10 days and hospitalization >28 days in the reduced group was higher than that in the normal group (P<0.05). According to logistic regression analysis, the risk factors for pituitary dysfunction included GCS score<5, intracranial pressure ≥20 mmHg, midline displacement ≥5 mm, skull base fracture and diffuse cerebral edema. The inclusion of GCS score<5, intracranial pressure ≥20 mmHg, midline displacement ≥5 mm, skull base fracture and diffuse cerebral edema in receiver operating characteristic (ROC) analysis had higher clinical value in predicting pituitary dysfunction by combining various risk factors. Conclusions The risk of pituitary dysfunction after severe craniocerebral trauma is closely related to factors such as intracranial pressure, skull base fractures, diffuse brain edema, GCS scores and other factors. Clinical attention and timely intervention should be paid to ensure the life safety of patients.
关键词
重度颅脑创伤 /
垂体功能减退 /
影响因素 /
干预
Key words
severe craniocerebral trauma /
pituitary dysfunction /
influencing factors /
intervention
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 张剑宁,惠 瑞. 颅脑创伤的致伤机制、医疗现状与展望[J]. 中华医学杂志,2024,104(13):985-990.
[2] Plavov O, Martinez-Perez R, Garcia-Ballestas E,et al. Re: A national survey of clinical practice of surveillance for post-traumatic brain injury hypopituitarism in the United Kingdom and Ireland[J]. Br J Neurosurg,2021,35(6):800.
[3] Aungkawattanapong N, Jakchai K, Tempark T, et al. Recurrent hypoglycemic seizure as a presenting symptom of post-TBI hypopituitarism in children: a case report, review and proposed protocol[J]. J Pediatr Endocrinol Metab,2022,35(8):1078-1088.
[4] 江基尧.颅脑创伤临床救治指南[M].上海:第二军医大学出版社,2015:12-13.
[5] Bodien Y G, Barra A, Temkin N R, et al. Diagnosing level of cnsciousness: the limits of the Glasgow coma scale total score[J]. J Neurotrauma,2021,38(23):3295-3305.
[6] 尹倩倩,潘天荣,钟 兴,等. 腺垂体功能减退症123例临床分析[J]. 安徽医药,2023,27(6):1207-1210.
[7] Mohd Salleh N, Theophilus S C, Rahman N A A, et al. Chronic anterior pituitary dysfunction following traumatic head injury: prospective study in hospital sultanah aminah johor bahru, malaysia[J]. Malays J Med Sci, 2023,30(1):107-115.
[8] 冯 杰,冯贵龙,张嘉利,等. 重度颅脑创伤后垂体功能减退及其预测因子的探讨[J]. 中华内分泌外科杂志,2023,17(1):68-73.
[9] Gilis-Januszewska A, Kluczyński Ł, Hubalewska-Dydejczyk A. Traumatic brain injuries induced pituitary dysfunction: a call for algorithms[J]. Endocr Connect,2020 ,9(5):112-123.
[10] 陈 艾,程 波,苏 俊,等. 颅脑创伤后垂体功能减退的列线图预测模型构建[J]. 现代医学,2023,51(4):447-454.
[11] 梁前垒,郭永川,李朝晖. 重型颅脑创伤患者早期并发腺垂体功能减退的临床诊治分析[J]. 中华内分泌外科杂志,2020,14(1):56-59.
[12] 孙振国,杨 阳,孙建新,等. 颅脑创伤后垂体功能减退的危险因素分析[J]. 临床神经外科杂志,2020,17(6):711-713.
[13] 翟一轩,杨凤东,李建国,等. 无功能垂体神经内分泌肿瘤术后垂体功能减退的影响因素分析[J]. 中华神经外科杂志,2024,40(6):559-563.
[14] Emelifeonwu J A, Flower H, Loan J J, et al. Prevalence of anterior pituitary dysfunction twelve months or more following traumatic brain injury in adults: a systematic review and meta-analysis[J]. J Neurotrauma,2020,37(2):217-226.
[15] 潘 立,谢理政,程宏伟,等. 创伤性颅脑损伤后垂体功能减退[J]. 中华神经创伤外科电子杂志,2023,9(5):308-312.
[16] 冯双双,潘行山,李 娟,等. 成人腺垂体功能减退症患者临床特征及并发感染的危险因素[J]. 中国医师杂志,2023,25(5):704-708.
[17] 黄 蓓,刘隆福,冯松山,等. 成人无功能性垂体腺瘤患者术后垂体功能减退对骨密度和身体成分的影响[J]. 中国骨质疏松杂志,2022,28(1):21-25,36.
[18] 李平根,王楠斐,黄国兵,等. 动脉瘤性蛛网膜下腔出血术后垂体功能减退的临床研究[J]. 国际神经病学神经外科学杂志,2022,49(2):61-64.
[19] 夏友娟,曹卫娟. 垂体前叶功能减退症的病因及诊疗研究进展[J]. 河北医药,2024,46(1):128-132.
[20] 王诗蕊,朱惠娟. 垂体前叶功能减退的临床诊治进展[J]. 临床内科杂志,2022,39(8):508-511.
基金
广东省医学科学技术研究基金(B2024041)
PDF(1317 KB)
