皮质醇对老年高血压性脑出血预后的影响
摘要
目的探讨皮质醇对老年高血压性脑出血患者预后的影响。方法回顾性观察118例年龄65岁以上高血压脑出血患者入院后进行血清皮质8 am和4 pm测定并评估其对预测3个月后神经功能的价值。结果与3个月时良好预后患者相比,不良预后患者皮质醇明显升高;与存活患者相比,3个月时死亡患者皮质醇水平也明显升高,差异有统计学意义(P <0. 05)。作为功能预后工具,接受者操作特征表明入院后血清皮质醇的曲线下面积(AUC)与NIHSS或ICH评分差异无统计学意义(P> 0. 05);对于病死率预测方面,皮质醇与NIHSS或ICH评分差异无统计学意义(P> 0. 05)。多元logistic回归模型校正NIHSS、ICH评分、年龄、出血量、8 am及4 pm皮质醇后,8 am皮质醇、出血量及NIHSS与不良功能预后独立相关。见表3。结论皮质醇升高与老年高血压性脑出血患者3个月不良神经功能预后及病死率升高相关,清晨皮质醇可能作为预测预后的血清标志物。
引文
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[3]Neidert S,Katan M,Schuetz P,et al.Anteriorpituitary axis hormones and outcome in acute ischaemic stroke[J].J Intern Med,2011,269(4):420-432.
[4]Zweifel C,Katan M,Schuetz P,et al.Growth hormone and outcome in patients with intracerebral hemorrhage:a pilot study[J].Biomarkers,2011,16(6):511-516.
[5]Huttner HB,Kiphuth IC,Teuber L,et al.Neuroendocrine changes in patients with spontaneous supratentorial intracerebral hemorrhage[J].Neurocrit Care,2013,18(1):39-44.
[6]孙业富,夏爱萍,张志锋,等.不同时间点测定血浆皮质醇水平在自发性脑出血患者的应用及评价[J].广东医学,2017,38(3):420-424.
[7]中华医学会神经病学分会.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[8]Kothari RU,Brott T,Broderick JP,et al.The ABCs of measuring intracerebral hemorrhage volumes[J].Stroke,1996,27(8):1304-1305.
[9]Vespa PM.Hormonal dysfunction in neurocritical patients[J].Curr Opin Crit Care,2013,19(2):107-112.
[10]Christensen H1,Boysen G,Johannesen HH.Serum-cortisol reflects severity and mortality in acute stroke[J].J Neurol Sci,2004,217(2):175-180.
[11]Sorrells SF,Sapolsky RM.An inflammatory review of glucocorticoid actions inthe CNS[J].Brain Behav Immun,2007,21(3):259-272.
[12]Zucchi FC,Matthies NF,Badr N,et al.Stress-induced glucocorticoid receptor activation determines functional recovery following ischemic stroke[J].Exp Transl Stroke Med,2010,2(1):18.
[13]Dinkel K,Mac Pherson A,Sapolsky RM.Novel glucocorticoid effects on acute inflammation in the CNS[J].J Neurochem,2003,84(4):705-716.
[14]Mac Pherson A,Dinkel K,Sapolsky R.Glucocorticoids worsen excitotoxin-induced expression of pro-inflammatory cytokines in hippocampal cultures[J].Exp Neurol,2005,194(2):376-383.
[15]Bao AM,Meynen G,Swaab DF.The stress system in depression andneurodegeneration focus on the human hypothalamus[J].Brain Res Rev,2008,57(2):531-553.
[16]Reynolds RM,Labad J,Strachan MW,et al.Elevatedfasting plasma cortisol is associated with ischemic heart disease and its risk factors in people with type 2 diabetes:the Edinburgh type 2diabetes study[J].J Clin Endocrinol Metab,2010,95(4):1602-1608.