摘要
目的:探讨颅脑外伤后血清甲状腺激素水平变化的规律,以研究颅脑外伤后血清甲状腺激素水平变化的临床意义。方法:选择79例颅脑外伤患者为对象,根据格拉斯哥(GCS)评分分为轻度(B),中度(C),重度(D)三组,D组又分为存活组(D1)和死亡组(D2);选择30例体检健康人员为对照组(A)。颅脑外伤患者分别在入院后第1d(12～36)h,第7d早晨6:00～7:00采集血清,对照组只采一次。检测血T3、T4、FT3、FT4、TSH、rT3。结果进行统计学分析。结果:①入院第1d与对照组相比三组的rT3均升高,TSH均降低(P<0.05,P<0.001,P<0.001);中度组、重度组与对照组相比T3下降(P<0.05,P<0.001),FT3下降(均P<0.001),重度组T4与对照组相比有所下降(P<0.05),各组的FT4相比无显著性差异(P>0.05)。②随着格拉斯哥评分的减少,T3、T4、FT3、TSH逐渐降低,rT3逐渐升高,各组间相比差异有显著性,FT4无明显改变。③一周内,重度组T3,FT3进一步下降,差异有显著性;中度组、重度组TSH逐步恢复,T4,FT4仍然无显著变化。④重度组死亡病例中(6/13)出现了TSH升高(最高的33.46mIU/L,最低的8.25mIU/L)。结论:①颅脑外伤伴有甲状腺激素水平的变化,以低T3、FT3、TSH,高rT3为主,严重者出现低T4。②颅脑外伤后甲状腺激素水平的变化的程度,持续的时间与病情的轻重相关,病情越重,变化的程度越大,持续的时间越长。③重度颅脑外伤发生TSH升高,预后可能极差。④血清甲状腺激素的检测,结合GCS评分对颅脑外伤病人的预后判断有一定的应用价值。
Objective To investigate the clinical significance of changes of serum thyroid - related hormones levels in patients with craniocerebral injury. Methods Serum T3, T4, FT3, FT4, TSH （with CLIA） and FT3（with RIA） levels were measured in 79 patients with head injury both on admission and 7 days Later （in the 66 survivors） as well as once in 30 controls. The 79 patients con- sistod of the following groups ： ① mild, Glascow score 13 - 15, n = 21 ② moderate, score 8 - 12, n = 26 ③ severe, score 〈 8, n = 32. Of the 32 severe eases, 13 succumbed within 7 days. Results ①On admission, the serum rT3 levels in all the patients groups were significantly higher than those in controls （ P 〈 0.05, P 〈 0. 001, P 〈 0.001 ）, while TSH levels were significantly lower （ P 〈 0. 05, P 〈 0. 001 ,P 〈 0.001 ）. T3, FT3 levels in moderate and severe groups were significantly lower than those in controls （ P 〈 0.05, P 〈 0.001, P 〈 0. 001, P 〈 0. 001 ）. T4 levels in severe groups were lower than those in controls （ P 〈 0.05 ）. b-T4 levels showed no significant differences among all four groups （ P 〉 0.05 ）. ②Serum T3, FT3 and TSH levels decreased while rT3 levels increased as Glascow score decreased with significant differences between levels in different groups. ③ There were significant further decreases of T3 and FT3 levels in the survived patients of severe group 7 days Later （P 〈 0.05, P 〈 0.001 ）. There were no differences between the levels of T4, FT4 and rT3 on 1^st and 7^th day in the moderate and severe groups with significant recovery of TSH levels. ④ A very remarkable increase of TSH levels （8.25mIU/L - 33.46mIU/L） was observed in 6 of the 13 succumbed patients. Conclusion ① Craniocerebral injury was associated with changes in serum thyroid - related hormones levels characterized by low T3, FT3, TSH and high rT3. Low T4 levels might be present in severe cases. ② The magnitude and duration of the change of hormone levels were positively correLated with the severity of injury. ③ Marked elevation of TSH levels in severe eases was an ominous sign. ④ Along with GLascow score, determination of levels of thyroid - related hormones changes might be helpful for ontcome prediction.
出处
《放射免疫学杂志》
CAS
2007年第5期401-403,共3页
Journal of Radioimmanology
