重型颅脑损伤患者垂体前叶激素变化及临床意义
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摘要
背景:创伤性颅脑损伤(traumatic brain injury TBI)已经成为威胁公众健康的严重问题。近年来研究发现,TBI后垂体前叶激素异常的发生率并不低,垂体机能异常减退可能导致或加重TBI造成的患者躯体、认知、心理方面的损伤并影响康复治疗,如及时发现垂体前叶激素异常及其变化规律并采取有效治疗措施,有可能提高对伤情评估和预后判断的准确性,并改善TBI患者的预后。
目的:通过测定重型TBI(sTBI)患者伤后不同时间点血清中生长激素(GH),促甲状腺激素(TSH),卵泡刺激素(FSH),黄体生成素(LH)和泌乳素(PRL)的含量,初步探讨垂体前叶激素异常的发生率、变化规律以及与伤情和预后之间的关系。为临床诊断外伤后垂体前叶激素异常和采用激素替代疗法改善患者预后提供更多的研究数据。
方法:随机选取2006年1月～2006年12月间急性sTBI住院患者48例作为脑创伤组,再按入院时GCS的不同划分为重型组和特重型组。于伤后第1,7,14,21天分别抽取患者静脉血3ml,分离血清,采用化学发光法测定垂体前叶激素含量。另随机选取20例健康志愿者作为对照组,取静脉血一次进行测定。以上各组年龄、性别均无明显差异。脑创伤组患者在伤后3个月时,根据病历记录或随访结果,按GOS评分标准分为预后不良组(GOS≤3)和预后良好组(GOS＞3)。
结果:(1)伤后FSH和LH异常的发生率可高达到52.1%和45.8%。(2)重型组及特重型组伤后第1天GH和TSH水平与对照组比较具有统计学意义(P＜0.05)。重型组及特重型组伤后第1、7、14、21天FSH和LH水平与对照组比较具有统计学意义(P＜0.05)。重型组与特重型组比较不具有统计学意义(P＞0.05)。(3)预后不良组患者伤后第1天TSH水平与预后良好组比较具有统计学意义(P＜0.05),随后的3次测定与预后良好组比较也具有统计学意义(P＜0.05)。预后不良组患者伤后第1、7、14、21天的FSH和LH水平与预后良好组比较具有统计学意义(P＜0.05)。预后不良组伤后第1天GH和PRL水平与预后良好组比较具有统计学意义(P＜0.05)。
结论:(1)sTBI后FSH和LH变化发生最为常见。(2)伤后垂体前叶激素可发生明显变化,重型组及特重型组伤后第1天GH和TSH高于对照组,重型组及特重型组伤后第1、7、14、21天的FSH和LH水平低于对照组,随着伤后病情好转及时间的推移垂体分泌功能呈现不同程度恢复。急性sTBI患者伤后垂体前叶激素的变化程度与伤情的没有明显的联系。(3)sTBI患者伤后垂体激素的动态变化对于判断预后有重要参考价值,凡是伤后第1天出现垂体前叶激素水平明显高于或低于正常值,随后呈持续低水平者,提示预后不良;伤后第1天垂体前叶激素水平变化明显但能够很快恢复以及伤后激素水平变化不大者,提示预后良好。
Background: Traumatic brain injury (TBI) has already became the serious problem threaten public health. In recent studies, the change of Anterior pituitary hormone is not rare after TBI, the pituitary function abnormality may exacerbate existing impairments of physical, cognitive caused by TBI, if Anterior pituitary hormone abnormality can be diagnosed timely and the rules of dynamic change can be found, we can evaluate the outcome more properly and improved the outcome.
Objective: By measure the levels of the GH, TSH, FSH, LH and PRL on the patients suffered sTBI in different times after hospitalized. To stude the rule of the dynamic changes and to investigate the relationship between pituitary function abnormality and the outcome. So we can know more about the clinical diagnosis and the hormone substitution therapy to improve the outcome.
Methods: From January, 2006 to December, 2006, 48 cases of the hospitalized patients with acute sTBI were enrolled to be traumatic group and measured the levels of the GH, TSH, FSH, LH and PRL on 1st, 7th, 14th, 21st days after hospitalized . meanwhile, 20 normal control persons were sellected and measured the same hormones. Clinical outcomes were valued by using the Glasgow Outcome Scale score(GOSs) at 3 months after injury.
Results: (1) The incidences of abnormality about FSH and LH can reach as high as to 52.1% and 45.8%. (2) On 1st day, Statistics significance (P < 0.05) can be observed when we compare TSH in ssTBI group and sTBI group to normal control group. On 1st, 7th, 14th, 21st days after hospitalized, Statistics significance (P < 0.05) can be observed when we compare FSH and LH levels in ssTBI group and sTBI group to normal control group. There is no statistics significance between ssTBI group and sTBI group. (3) On 1st day after hospitalized, the TSH level in poor outcome group was significantly higher than the one in the favorable outcome group, but on 7th, 14th, 21st days, the level was significantly lower. On 1st, 7th, 14th, 21st days, the FSH and LH levels in poor outcome group was significantly lower than the levels in the favorable outcome group. On 1st day, the GH and PRL levels in poor outcome group was significantly higher than the levels in the favorable outcome group.
Conclusion: (1) The change of FSH and LH is the most common with the patients after sTBI. (2) The Anterior pituitary hormone may significantly change after TBI. On the 1st day, TSH level in ssTBI group and sTBI group is higher than the normal control group. On 1st, 7th, 14th, 21st days, FSH and LH levels in ssTBI group and sTBI group lower than the normal control group. When condition of the patients became better, the pituitary function seem can be improved gradually. But there is no significant relationship between the change of the hormones and severity. (3) The change of the change of the anterior pituitary hormone can be use to predicating the outcome of the sTBI. The hormone level of the patients in poor outcome group will significantly change on 1st day after injure or decrease fiercely in follow days. On the contrary, the patient whose hormone level change slightly or can be greatly improved will have favorable outcome.
目的:通过测定重型TBI(sTBI)患者伤后不同时间点血清中生长激素(GH),促甲状腺激素(TSH),卵泡刺激素(FSH),黄体生成素(LH)和泌乳素(PRL)的含量,初步探讨垂体前叶激素异常的发生率、变化规律以及与伤情和预后之间的关系。为临床诊断外伤后垂体前叶激素异常和采用激素替代疗法改善患者预后提供更多的研究数据。
方法:随机选取2006年1月～2006年12月间急性sTBI住院患者48例作为脑创伤组,再按入院时GCS的不同划分为重型组和特重型组。于伤后第1,7,14,21天分别抽取患者静脉血3ml,分离血清,采用化学发光法测定垂体前叶激素含量。另随机选取20例健康志愿者作为对照组,取静脉血一次进行测定。以上各组年龄、性别均无明显差异。脑创伤组患者在伤后3个月时,根据病历记录或随访结果,按GOS评分标准分为预后不良组(GOS≤3)和预后良好组(GOS＞3)。
结果:(1)伤后FSH和LH异常的发生率可高达到52.1%和45.8%。(2)重型组及特重型组伤后第1天GH和TSH水平与对照组比较具有统计学意义(P＜0.05)。重型组及特重型组伤后第1、7、14、21天FSH和LH水平与对照组比较具有统计学意义(P＜0.05)。重型组与特重型组比较不具有统计学意义(P＞0.05)。(3)预后不良组患者伤后第1天TSH水平与预后良好组比较具有统计学意义(P＜0.05),随后的3次测定与预后良好组比较也具有统计学意义(P＜0.05)。预后不良组患者伤后第1、7、14、21天的FSH和LH水平与预后良好组比较具有统计学意义(P＜0.05)。预后不良组伤后第1天GH和PRL水平与预后良好组比较具有统计学意义(P＜0.05)。
结论:(1)sTBI后FSH和LH变化发生最为常见。(2)伤后垂体前叶激素可发生明显变化,重型组及特重型组伤后第1天GH和TSH高于对照组,重型组及特重型组伤后第1、7、14、21天的FSH和LH水平低于对照组,随着伤后病情好转及时间的推移垂体分泌功能呈现不同程度恢复。急性sTBI患者伤后垂体前叶激素的变化程度与伤情的没有明显的联系。(3)sTBI患者伤后垂体激素的动态变化对于判断预后有重要参考价值,凡是伤后第1天出现垂体前叶激素水平明显高于或低于正常值,随后呈持续低水平者,提示预后不良;伤后第1天垂体前叶激素水平变化明显但能够很快恢复以及伤后激素水平变化不大者,提示预后良好。
Background: Traumatic brain injury (TBI) has already became the serious problem threaten public health. In recent studies, the change of Anterior pituitary hormone is not rare after TBI, the pituitary function abnormality may exacerbate existing impairments of physical, cognitive caused by TBI, if Anterior pituitary hormone abnormality can be diagnosed timely and the rules of dynamic change can be found, we can evaluate the outcome more properly and improved the outcome.
Objective: By measure the levels of the GH, TSH, FSH, LH and PRL on the patients suffered sTBI in different times after hospitalized. To stude the rule of the dynamic changes and to investigate the relationship between pituitary function abnormality and the outcome. So we can know more about the clinical diagnosis and the hormone substitution therapy to improve the outcome.
Methods: From January, 2006 to December, 2006, 48 cases of the hospitalized patients with acute sTBI were enrolled to be traumatic group and measured the levels of the GH, TSH, FSH, LH and PRL on 1st, 7th, 14th, 21st days after hospitalized . meanwhile, 20 normal control persons were sellected and measured the same hormones. Clinical outcomes were valued by using the Glasgow Outcome Scale score(GOSs) at 3 months after injury.
Results: (1) The incidences of abnormality about FSH and LH can reach as high as to 52.1% and 45.8%. (2) On 1st day, Statistics significance (P < 0.05) can be observed when we compare TSH in ssTBI group and sTBI group to normal control group. On 1st, 7th, 14th, 21st days after hospitalized, Statistics significance (P < 0.05) can be observed when we compare FSH and LH levels in ssTBI group and sTBI group to normal control group. There is no statistics significance between ssTBI group and sTBI group. (3) On 1st day after hospitalized, the TSH level in poor outcome group was significantly higher than the one in the favorable outcome group, but on 7th, 14th, 21st days, the level was significantly lower. On 1st, 7th, 14th, 21st days, the FSH and LH levels in poor outcome group was significantly lower than the levels in the favorable outcome group. On 1st day, the GH and PRL levels in poor outcome group was significantly higher than the levels in the favorable outcome group.
Conclusion: (1) The change of FSH and LH is the most common with the patients after sTBI. (2) The Anterior pituitary hormone may significantly change after TBI. On the 1st day, TSH level in ssTBI group and sTBI group is higher than the normal control group. On 1st, 7th, 14th, 21st days, FSH and LH levels in ssTBI group and sTBI group lower than the normal control group. When condition of the patients became better, the pituitary function seem can be improved gradually. But there is no significant relationship between the change of the hormones and severity. (3) The change of the change of the anterior pituitary hormone can be use to predicating the outcome of the sTBI. The hormone level of the patients in poor outcome group will significantly change on 1st day after injure or decrease fiercely in follow days. On the contrary, the patient whose hormone level change slightly or can be greatly improved will have favorable outcome.
引文
[1] Ghajar. Traumatic brain injury[J]. Lancet,2000,356,923-929.
[2] Ruchholtz S, Nast-Kolb D. Craniocerebral trauma[J]. Chirurg 2002,73, 194-207.
[3] 只达石,崔世民,张赛. 重型颅脑损伤救治规范[M]. 北京：人民卫生出版社,2002.
[4] Ghigo E, Masel B, Aimaretti G,et al. Consensus guidelines on screening for hypopituitarism following traumatic brain injury[J]. Brain Inj. 2005,19:711-724.
[5] Kelly DF, Gonzalo IT,Cohan P,et al. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report [J]. Neurosurg ,2000,93:743-752.
[6] Eledrisi M.S, Urban R.J, and Lieberman S.A. Brain injury and neuroendocrine function[J]. Endocrinologist 2001,11, 275-281.
[7] Aimaretti G, Cornelli P, Razzore P, et al. Comparison between insulin-induced hypoglycemia and growth hormone (GH)-releasing hormone + arginine asprovocative tests for the diagnosis of GH deficiency in adults [J]. Clin. Endocrinol. Metab. 1998,83, 1615-1618.
[8] Bondanelli M, DE Marinis, L, Ambrosio MR, et al. Occurrence of pituitary dysfunction following traumatic brain injury [J]. Neurotrauma 2004,21, 685-696.
[9] Lieberman S, Oberoi A, Gilkinson C, et al. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury [J]. Clin Endocrinol Metab 2001,86:2752.
[10] Agha A, Rogers B, Sherlock M, et al. Anterior pituitary dysfunction in survivors of traumatic brain injury[J]. Clin Endocrinol Metab 2004,89:4929.
[11] Popovic V, Pekic S, Pavlovic D, et al.Hypopituitarism as a consequence of traumatic brain injury(TBI) and its possible relation with cognitive disabilities and mental distress [J]. Endocrinol Invest 2004,27:1048.
[12] Dimopoulou I, Tsagarakis S, Theodorakopoulou M, et al. Endocrine abnormalities in critical care patients with moderate-to-severe head trauma: incidence, pattern and predisposing factors[J]. Intensive Care Med. 2004,30, 1051-1057.
[13] Wildburger R, Zarkovic N, Lab G,et al.Post-traumatic changes in insulin-like growth factor type 1 and growth hormone in patients with bone fractures and traumatic brain injury[J].Wien Klin Wochenschr,2001,133: 119-126.
[14] Darzy KH, Aimaretti G, Wieringa G,et al. The usefulness of the combined growth hormone (GH)-releasing hormone and arginine stimulation test in the diagnosis of radiation-induced GH deficiency is dependent on the post-irradiation time interval[J].Clin Endocrinol Metab,2003,88:95-102.
[15]马景鉴,吕务军,王明璐,等.重型颅脑损伤中甲状腺激素和皮质醇的变化及其临床意义[J].中华神经外科杂志.1992,8:83.
[16]陈柏香.TBI患者血清甲状腺激素水平的变化及临床意义[J].放射免疫学杂志.2006.19(1):42-43.
[17]Chiolero R,Leamarchand T,Schutz Y,et al.Plasma pituitary hormone level in severe trauma with or without head injury[J].Trauma,1988,28(9):1368-1374.
[18]罗盛平.急性颅脑损伤后血清甲状腺素和促甲状腺素的研究[J].中华神经:外科疾病研究杂志,2004,3(4):
[19]李冰,李宗敏,郭建欣,等.6496例颅脑损伤的流行病学特征[J].中华神经外科杂志,2005.21:197-199.
[20]刘窗溪,熊云彪,韩图强.等.CT扫描动态观察急性外伤性颅内血肿[J].中华神经外科杂志,2005,21:211-212.
[21]Su DH,Chang YC,Chang CC.Post-traumatic anterior and posterior pituitary dysfunction[J].Formos Med Assoc,2005,104:463-467.
[22]Samadani U,Reyes-Moreno I,Buchfelder M.Endocrine dysfunction following traumatic brain injury:mechanisms,pathophysiology and clinical correlations[J].Acta Neurochir Suppl,2005,93:121-125.
[23]Agha A,Thornton E,OKelly P.Posterior pituitary dysfunction after traumatic brain injury[J].Clin Endocrinol Metab,2004,89:5987-5992.
[24]Schneider HJ.Schneider M.Rosen FV.Pituitary insufficiency following head injury-how common is it,and what is to be done?[J].MMW Forschr Med.2004.146:41-44.
[25]孙为群,滕良珠,张健.急性TBI患者下丘脑垂体前叶激素变化的临床意义[J].山东大学学报.2004.42(4):448-455.
[26]Hwang SL,lieu AS,Hownag SL.Hypothalamic dysfunction in acute head-injured patients with stress ulcer[J].Kaohsiung Journal of Medical Science,1998,14(9):554-560.
[27]Tomlinson JW,Holden N,Hills RK,et al.Association between premature mortality and hypopituitarism.West Midlands Prospective Hypopituitary Study Group[J].Lancet 2001,357,425-431.
[28] Nylen ES, Muller B. Endocrine changes in critical illness [J]. Intensive Care Med,2004,19:67-82.
[29] Vanden BG. Novel insights into the neuroendocrinology of critical illness. Eur [J]. Endocrinol.2000,143,1-13.
[30] Woolf PD, Hamill RW, Mcdonald JV, et al.Transient hypogonadotrophic hypogonadism after head trauma: effects on steroid precursors and correlation with sympathetic nervous system activity[J]. Clin. Endocrinoi. 19862,5,265-274.
[31] Sobrinho LG. Prolactin, psychological stress and environment in humans: adaptation and maladaptation[J]. Pituitary 2003,6,35-39.
[32] Yuan XQ,Wade CE.Neuroendocrine abnormalities in patients with traumatic brain injury[J].Front Neuroendocrinol,1991,12:209-230.
[33] Kelly DF, Gonzalo IT,Cohan P,et al. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report [J]. Neurosurg.2000,93:743-752.
[34] Edwards OM, and Clark J DA. Post-traumatic hypopituitarism: six cases and a review of the literature. Medicine 1986,65,281-290.
[35] Iglesias P,Gomez-Pan,A,and Diez, J.J. Spontaneous recovery from post-traumatic hypopituitarism [J]. Endocrinoi. Invest.1996,320-323.
[36] Aimaretrl G, Ambrosio MR, Disomma C, et al.Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury[J]. Clin. Endocrinoi. (Oxf.) 2004,61, 320-326.
[37] Kelly DF, Gonzalo IT,Cohan P,et al. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report [J]. Neurosurg ,2000,93:743-752.
[38] Greenwood R. Head injury for neurologists [J]. Neurol.Neurosurg. Psychiatry 2002,73, Suppl 1, i8-i16.
[39] Hassan A, Crompton JL, and Sandhu A.Traumatic chiasmal syndrome: a series of 19 patients[J]. Clin.Exp. Ophthalmol. 2002,30, 273-280.
[40] Barreca T, Perria C, Sannia A,et al. Evaluation of anterior pituitary function in patients with posttraumatic diabetes insipidus [J]. Endocrinoi. Metab. 1980,51,1279-1282.
[41] Benvenga S, Campenn A., Ruggeri RM,et al. Hypopituitarism secondary to head trauma [J]. Clin. Endocrinoi. Metab. 2000,85, 1353-1361.
[42] Lieberman SA, Oberoi AL, Gilkison CR, et al. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury [J]. Clin. Endocrinol. Metab. 2001,86,2752-2756.
[43] Agha A,Rogers B,Sherlock M,et al. Anterior pituitary dysfunction in survivors of traumatic brain injury [J]. Glin Endocrinol Metab.2004,89:4929-4936.
[44] Casanueva FF, Leal A, Koltowska-Haggstrom M, et al.Traumatic brain injury as a relevant cause of growth hormone deficiency in adults: A KIMS-based study[J].Arch Phys Med Rehabil. 2005;86(3): 463 -468.
[45] Carroll PV, Christ ER, Bengtsson BA, et al.Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. Growth Hormone Research Society Scientific Committee [J]. Clin Endocrinol Metab. 1998;83(2):382-395.
[46] Elovic PE. Anterior pituitary dysfunction after traumatic brain injury, Part I [J]. Head Trauma Rehabil. 2003;18(6):541-543.
[47] Elovic PE, Glenn MB. Anterior pituitary dysfunction after traumatic brain injury, part II [J]. Head Trauma Rehabil. 2004; 19(2): 184-187.
[1] Elovic EP. Anterior pituitary dysfunction after traumatic brain injury [J].Head Trauma Rehabil, 2003 ,18:541-543.
[2] Van den Berghe G. Novel insights into the neuroendocrinology of critical illness[J].Eur J Endocrinol, 2000,143:1-13.
[3] Wildburger R, Zarkovic N, Leb G,et al.Post-traumatic changes in insulin-like growth factor type 1 and growth hormone in patients with bone fractures and traumatic brain injury[J].Wien Klin Wochen- schr,2001,133: 119-126.
[4] Agha A,Rogers B,Sherlock M,et al. Anterior pituitary dysfunction in survivors of traumatic brain injury [J].Clin Endocrinol Metab,2004,89:4929-4936.
[5] Kelly DF, Gonzalo IT,Cohan P,et al. Hypopituitarism following traumatic brain injury and aneur- ysmal subarachnoid hemorrhage: a preliminary report [J]. Neurosurg ,2000,93:743-752.
[6] Yuan XQ,Wade CE. Neuroendocrine abnormalities in patients with traumatic brain injury[J]. Front Neuroendocrinol, 19-91,12:209-230.
[7] Nylen ES, Muller B. Endocrine changes in critical illness [J]. Intensive Care Med.,2004,19:67-82.
[8] Benvenga S, Campenni A, Ruggeri RM,et al. Hypopituitarism secondary to head trauma [J]. ClinEndocrinol Metab,2000, 85:1353-1361.
[9] Darzy KH, Aimaretti G, Wieringa G, et al. The usefulness of the combined growth hormone (GH)- releasing hormone and arginine stimulation test in the diagnosis of radiation-induced GH deficiency is dependent on the post-irradiation time interval [J].Clin Endocrinol Metab,2003, 88:95-102.
[10] Gomez JM, Espadero RM, Escobar-Jimenez F,et al. Growth hormone release after glucagon as a reliable test of growth hormone assessment in adults[J].Clin Endocrinol,2002,56:329-334.
[11] Sobrinho LG. Prolactin, psychological stress and environment in humans: adaptation and maladap- tation[J].Pituitary,2003,6: 35-39.
[12] Ghigo E, Masel B, Aimaretti G,et al. Consensus guidelines on screening for hypopituitarism following traumatic brain injury[J].Brain Inj, 2005,19:711-724.
[13] Elovic EP, Glenn MB.Anterior pituitary dysfunction after traumatic brain injury [J].Head Trauma Rehabil,2004,19:18-4-187.
[14] Popovic V, Aimaretti G, Casanueva FF,et al. Hypopituitarism following traumatic brain injury[J]. Growth Horm IGF Res,2005,15:177-184.
[2] Ruchholtz S, Nast-Kolb D. Craniocerebral trauma[J]. Chirurg 2002,73, 194-207.
[3] 只达石,崔世民,张赛. 重型颅脑损伤救治规范[M]. 北京：人民卫生出版社,2002.
[4] Ghigo E, Masel B, Aimaretti G,et al. Consensus guidelines on screening for hypopituitarism following traumatic brain injury[J]. Brain Inj. 2005,19:711-724.
[5] Kelly DF, Gonzalo IT,Cohan P,et al. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report [J]. Neurosurg ,2000,93:743-752.
[6] Eledrisi M.S, Urban R.J, and Lieberman S.A. Brain injury and neuroendocrine function[J]. Endocrinologist 2001,11, 275-281.
[7] Aimaretti G, Cornelli P, Razzore P, et al. Comparison between insulin-induced hypoglycemia and growth hormone (GH)-releasing hormone + arginine asprovocative tests for the diagnosis of GH deficiency in adults [J]. Clin. Endocrinol. Metab. 1998,83, 1615-1618.
[8] Bondanelli M, DE Marinis, L, Ambrosio MR, et al. Occurrence of pituitary dysfunction following traumatic brain injury [J]. Neurotrauma 2004,21, 685-696.
[9] Lieberman S, Oberoi A, Gilkinson C, et al. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury [J]. Clin Endocrinol Metab 2001,86:2752.
[10] Agha A, Rogers B, Sherlock M, et al. Anterior pituitary dysfunction in survivors of traumatic brain injury[J]. Clin Endocrinol Metab 2004,89:4929.
[11] Popovic V, Pekic S, Pavlovic D, et al.Hypopituitarism as a consequence of traumatic brain injury(TBI) and its possible relation with cognitive disabilities and mental distress [J]. Endocrinol Invest 2004,27:1048.
[12] Dimopoulou I, Tsagarakis S, Theodorakopoulou M, et al. Endocrine abnormalities in critical care patients with moderate-to-severe head trauma: incidence, pattern and predisposing factors[J]. Intensive Care Med. 2004,30, 1051-1057.
[13] Wildburger R, Zarkovic N, Lab G,et al.Post-traumatic changes in insulin-like growth factor type 1 and growth hormone in patients with bone fractures and traumatic brain injury[J].Wien Klin Wochenschr,2001,133: 119-126.
[14] Darzy KH, Aimaretti G, Wieringa G,et al. The usefulness of the combined growth hormone (GH)-releasing hormone and arginine stimulation test in the diagnosis of radiation-induced GH deficiency is dependent on the post-irradiation time interval[J].Clin Endocrinol Metab,2003,88:95-102.
[15]马景鉴,吕务军,王明璐,等.重型颅脑损伤中甲状腺激素和皮质醇的变化及其临床意义[J].中华神经外科杂志.1992,8:83.
[16]陈柏香.TBI患者血清甲状腺激素水平的变化及临床意义[J].放射免疫学杂志.2006.19(1):42-43.
[17]Chiolero R,Leamarchand T,Schutz Y,et al.Plasma pituitary hormone level in severe trauma with or without head injury[J].Trauma,1988,28(9):1368-1374.
[18]罗盛平.急性颅脑损伤后血清甲状腺素和促甲状腺素的研究[J].中华神经:外科疾病研究杂志,2004,3(4):
[19]李冰,李宗敏,郭建欣,等.6496例颅脑损伤的流行病学特征[J].中华神经外科杂志,2005.21:197-199.
[20]刘窗溪,熊云彪,韩图强.等.CT扫描动态观察急性外伤性颅内血肿[J].中华神经外科杂志,2005,21:211-212.
[21]Su DH,Chang YC,Chang CC.Post-traumatic anterior and posterior pituitary dysfunction[J].Formos Med Assoc,2005,104:463-467.
[22]Samadani U,Reyes-Moreno I,Buchfelder M.Endocrine dysfunction following traumatic brain injury:mechanisms,pathophysiology and clinical correlations[J].Acta Neurochir Suppl,2005,93:121-125.
[23]Agha A,Thornton E,OKelly P.Posterior pituitary dysfunction after traumatic brain injury[J].Clin Endocrinol Metab,2004,89:5987-5992.
[24]Schneider HJ.Schneider M.Rosen FV.Pituitary insufficiency following head injury-how common is it,and what is to be done?[J].MMW Forschr Med.2004.146:41-44.
[25]孙为群,滕良珠,张健.急性TBI患者下丘脑垂体前叶激素变化的临床意义[J].山东大学学报.2004.42(4):448-455.
[26]Hwang SL,lieu AS,Hownag SL.Hypothalamic dysfunction in acute head-injured patients with stress ulcer[J].Kaohsiung Journal of Medical Science,1998,14(9):554-560.
[27]Tomlinson JW,Holden N,Hills RK,et al.Association between premature mortality and hypopituitarism.West Midlands Prospective Hypopituitary Study Group[J].Lancet 2001,357,425-431.
[28] Nylen ES, Muller B. Endocrine changes in critical illness [J]. Intensive Care Med,2004,19:67-82.
[29] Vanden BG. Novel insights into the neuroendocrinology of critical illness. Eur [J]. Endocrinol.2000,143,1-13.
[30] Woolf PD, Hamill RW, Mcdonald JV, et al.Transient hypogonadotrophic hypogonadism after head trauma: effects on steroid precursors and correlation with sympathetic nervous system activity[J]. Clin. Endocrinoi. 19862,5,265-274.
[31] Sobrinho LG. Prolactin, psychological stress and environment in humans: adaptation and maladaptation[J]. Pituitary 2003,6,35-39.
[32] Yuan XQ,Wade CE.Neuroendocrine abnormalities in patients with traumatic brain injury[J].Front Neuroendocrinol,1991,12:209-230.
[33] Kelly DF, Gonzalo IT,Cohan P,et al. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report [J]. Neurosurg.2000,93:743-752.
[34] Edwards OM, and Clark J DA. Post-traumatic hypopituitarism: six cases and a review of the literature. Medicine 1986,65,281-290.
[35] Iglesias P,Gomez-Pan,A,and Diez, J.J. Spontaneous recovery from post-traumatic hypopituitarism [J]. Endocrinoi. Invest.1996,320-323.
[36] Aimaretrl G, Ambrosio MR, Disomma C, et al.Traumatic brain injury and subarachnoid haemorrhage are conditions at high risk for hypopituitarism: screening study at 3 months after the brain injury[J]. Clin. Endocrinoi. (Oxf.) 2004,61, 320-326.
[37] Kelly DF, Gonzalo IT,Cohan P,et al. Hypopituitarism following traumatic brain injury and aneurysmal subarachnoid hemorrhage: a preliminary report [J]. Neurosurg ,2000,93:743-752.
[38] Greenwood R. Head injury for neurologists [J]. Neurol.Neurosurg. Psychiatry 2002,73, Suppl 1, i8-i16.
[39] Hassan A, Crompton JL, and Sandhu A.Traumatic chiasmal syndrome: a series of 19 patients[J]. Clin.Exp. Ophthalmol. 2002,30, 273-280.
[40] Barreca T, Perria C, Sannia A,et al. Evaluation of anterior pituitary function in patients with posttraumatic diabetes insipidus [J]. Endocrinoi. Metab. 1980,51,1279-1282.
[41] Benvenga S, Campenn A., Ruggeri RM,et al. Hypopituitarism secondary to head trauma [J]. Clin. Endocrinoi. Metab. 2000,85, 1353-1361.
[42] Lieberman SA, Oberoi AL, Gilkison CR, et al. Prevalence of neuroendocrine dysfunction in patients recovering from traumatic brain injury [J]. Clin. Endocrinol. Metab. 2001,86,2752-2756.
[43] Agha A,Rogers B,Sherlock M,et al. Anterior pituitary dysfunction in survivors of traumatic brain injury [J]. Glin Endocrinol Metab.2004,89:4929-4936.
[44] Casanueva FF, Leal A, Koltowska-Haggstrom M, et al.Traumatic brain injury as a relevant cause of growth hormone deficiency in adults: A KIMS-based study[J].Arch Phys Med Rehabil. 2005;86(3): 463 -468.
[45] Carroll PV, Christ ER, Bengtsson BA, et al.Growth hormone deficiency in adulthood and the effects of growth hormone replacement: a review. Growth Hormone Research Society Scientific Committee [J]. Clin Endocrinol Metab. 1998;83(2):382-395.
[46] Elovic PE. Anterior pituitary dysfunction after traumatic brain injury, Part I [J]. Head Trauma Rehabil. 2003;18(6):541-543.
[47] Elovic PE, Glenn MB. Anterior pituitary dysfunction after traumatic brain injury, part II [J]. Head Trauma Rehabil. 2004; 19(2): 184-187.
[1] Elovic EP. Anterior pituitary dysfunction after traumatic brain injury [J].Head Trauma Rehabil, 2003 ,18:541-543.
[2] Van den Berghe G. Novel insights into the neuroendocrinology of critical illness[J].Eur J Endocrinol, 2000,143:1-13.
[3] Wildburger R, Zarkovic N, Leb G,et al.Post-traumatic changes in insulin-like growth factor type 1 and growth hormone in patients with bone fractures and traumatic brain injury[J].Wien Klin Wochen- schr,2001,133: 119-126.
[4] Agha A,Rogers B,Sherlock M,et al. Anterior pituitary dysfunction in survivors of traumatic brain injury [J].Clin Endocrinol Metab,2004,89:4929-4936.
[5] Kelly DF, Gonzalo IT,Cohan P,et al. Hypopituitarism following traumatic brain injury and aneur- ysmal subarachnoid hemorrhage: a preliminary report [J]. Neurosurg ,2000,93:743-752.
[6] Yuan XQ,Wade CE. Neuroendocrine abnormalities in patients with traumatic brain injury[J]. Front Neuroendocrinol, 19-91,12:209-230.
[7] Nylen ES, Muller B. Endocrine changes in critical illness [J]. Intensive Care Med.,2004,19:67-82.
[8] Benvenga S, Campenni A, Ruggeri RM,et al. Hypopituitarism secondary to head trauma [J]. ClinEndocrinol Metab,2000, 85:1353-1361.
[9] Darzy KH, Aimaretti G, Wieringa G, et al. The usefulness of the combined growth hormone (GH)- releasing hormone and arginine stimulation test in the diagnosis of radiation-induced GH deficiency is dependent on the post-irradiation time interval [J].Clin Endocrinol Metab,2003, 88:95-102.
[10] Gomez JM, Espadero RM, Escobar-Jimenez F,et al. Growth hormone release after glucagon as a reliable test of growth hormone assessment in adults[J].Clin Endocrinol,2002,56:329-334.
[11] Sobrinho LG. Prolactin, psychological stress and environment in humans: adaptation and maladap- tation[J].Pituitary,2003,6: 35-39.
[12] Ghigo E, Masel B, Aimaretti G,et al. Consensus guidelines on screening for hypopituitarism following traumatic brain injury[J].Brain Inj, 2005,19:711-724.
[13] Elovic EP, Glenn MB.Anterior pituitary dysfunction after traumatic brain injury [J].Head Trauma Rehabil,2004,19:18-4-187.
[14] Popovic V, Aimaretti G, Casanueva FF,et al. Hypopituitarism following traumatic brain injury[J]. Growth Horm IGF Res,2005,15:177-184.