慢性意识障碍患者垂体相关激素变化及影响因素分析

杨艺; 党圆圆; 夏小雨; 徐珑; 陈雪玲; 耿小丽; 刘伟明; 何江弘

doi:10.16016/j.1000-5404.202103120

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慢性意识障碍患者垂体相关激素变化及影响因素分析

专题报道：意识障碍的基础与临床研究 | 更新时间：2026-01-09

- 慢性意识障碍患者垂体相关激素变化及影响因素分析
- Changes of pituitary hormones and related factors in patients with prolonged disorders of consciousness
- 第三军医大学学报 2021年43卷第15期页码：1430-1436
- 作者机构：
  
  1.100070 北京，首都医科大学附属北京天坛医院神经外科
  2.100700 北京，解放军总医院第七医学中心神经外科
- 作者简介：
  
  [何江弘，E-mail：he_jianghong@sina.com HE Jianghong, E-mail: he_jianghong@sina.com
- 基金信息：
  
  国家自然科学基金青年科学基金(81600919);北京市科技新星(Z181100006218050);利益冲突声明所有作者声明不存在利益冲突
- DOI：10.16016/j.1000-5404.202103120
  中图分类号： R335.1;R347;R749.13
- 收稿：2021-03-13，
  
  修回：2021-06-04，
  
  纸质出版：2021-08-15
- 稿件说明：
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杨艺, 党圆圆, 夏小雨, 等. 慢性意识障碍患者垂体相关激素变化及影响因素分析[J]. 第三军医大学学报, 2021,43(15):1430-1436.

Yi YANG, Yuanyuan DANG, Xiaoyu XIA, et al. Changes of pituitary hormones and related factors in patients with prolonged disorders of consciousness[J]. Journal of Third Military Medical University, 2021, 43(15): 1430-1436.
杨艺, 党圆圆, 夏小雨, 等. 慢性意识障碍患者垂体相关激素变化及影响因素分析[J]. 第三军医大学学报, 2021,43(15):1430-1436. DOI： 10.16016/j.1000-5404.202103120.

Yi YANG, Yuanyuan DANG, Xiaoyu XIA, et al. Changes of pituitary hormones and related factors in patients with prolonged disorders of consciousness[J]. Journal of Third Military Medical University, 2021, 43(15): 1430-1436. DOI： 10.16016/j.1000-5404.202103120.

摘要

目的

研究慢性意识障碍(prolonged disorders consciousness，pDOC)患者垂体相关激素水平变化及其与患者预后的相关性，分析激素水平与患者意识预后的高危因素。

方法

回顾性分析首都医科大学附属北京天坛医院神经外科及解放军总医院第七医学中心神经外科2018年1月至2020年12月收治的87例pDOC患者的临床资料，根据患者意识改善的情况，分为意识恢复组(39例)和意识未恢复组(48例)，测定两组患者的垂体相关激素的分泌水平，包括游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、促肾上腺皮质激素(ACTH)、生长激素(GH)、皮质醇(cortisol)、催乳激素(PRL)。根据昏迷恢复量表-修订版(coma recovery scale-revised，CSR-R)评分，将患者分为两个不同意识水平组: 植物状态(vegetative state

VS)组(61例)和微意识状态(minimally consciousness state

MCS)组(26例)，分析pDOC患者垂体相关激素的变化水平与意识的关系；根据激素水平的正常标准，将患者分为激素水平正常组(25例)与激素水平异常组(62例)，采用单因素分析和Logistic回归模型探讨pDOC患者垂体相关激素变化的影响因素。

结果

87例pDOC患者中62例发生垂体激素异常(71.3%)；42例发生单项激素异常(67.7%)，两项以上改变的有20例(32.3%)。垂体激素异常的类型例数及比例依次为: GH 18例(29.0%)、TSH及FT3/FT4 19例(30.6%)、PRL 11例(17.7%)、ACTH 8例(12.9%)、COR 6例(9.7%)。比较两个不同意识水平(VS组和MCS组)垂体相关激素水平之间的差异，发现两组GH、TSH、PRL、ACTH差异均有统计学意义(

0.01)。与激素水平正常组相比，激素水平异常组的发病年龄更高(

=0.001)，MCS患者所占比例(

=0.001)和CRS-R评分(

0.001)更低，ICU停留时间更长(

0.001)，而合并阵发性交感神经多度兴奋综合征(paroxysmal sympathetic hyperactivity，PSH)的比率更高(

=0.001)，单纯皮层损伤的比例偏低。采用多因素分析发现年龄(

=1.316，

=0.006)、CRS-R评分(

=0.200，

=0.037)，ICU停留时间(

=3.991，

=0.040)和PSH症状(

=11.874，

=0.045)是导致垂体激素异常的主要影响因素。

结论

pDOC患者垂体相关激素变化发生比例较高，与患者意识水平CRS-R评分正相关，年龄、ICU停留时间与PSH症状是垂体激素水平异常的危险因素。

Abstract

Objective

To study the changes of pituitary-related hormones in patients with prolonged disorders of consciousness (pDOC) and its influence on the prognosis of patient in order to explore the risk factor of hormone levels with consciousness level and prognosis of patients.

Methods

The clinical data of 87 pDOC patients admitted to the Department of Neurosurgery of Beijing Tiantan Hospital affiliated to Capital Medical University and the Department of Neurosurgery of the Seventh Medical Center of Chinese PLA General Hospital from January 2018 to December 2020 were analyzed retrospectively. According to the improvement of patients' consciousness

they were divided into consciousness recovery group (

=39) and consciousness non-recovery group (

=48). The secretion levels of pituitary related hormones were measured in the 2 groups

including free triiodothyronine (FT3)

free thyroxine (FT4)

thyroid stimulating hormone (TSH)

adrenocorticotropic hormone (ACTH)

growth hormone (GH) and cortisol and prolactin (PRL). According to Coma Recovery Scale-Revised (CSR-R) score

the patients were assigned into vegetative state VS group (

=61) and minimal consciousness state MCS group (

=26). The relationship between the changes of pituitary hormones and consciousness of pDOC patients was analyzed. According to the normal standard of hormone level

the patients were divided into normal hormone level group (

=25) and abnormal hormone level group (

=62). Univariate analysis and logistic regression model were used to explore the influencing factors (age

sex

cause of injury

course of disease

preoperative CRS-R score and injured location

etc.

) of pDOC patients.

Results

Among the 87 pDOC patients

62 (71.3%) had abnormal pituitary hormones

including 42 cases of single hormo

ne abnormality (67.7%)

and 20 cases of more than 2 changes (32.3%). The types and proportions of abnormal pituitary hormones were: GH 18 cases (29.0%)

TSH and FT3/FT4 19 cases (30.6%)

PRL 11 cases (17.7%)

ACTH 8 cases (12.9%)

and COR6 cases (9.7%). In the comparison of the differences of pituitary hormone levels between the VS group and MCS group

there were significant differences in GH

TSH

PRL and ACTH between the 2 groups (

0.01). Compared with the normal hormone level group

the abnormal hormone level group has an older onset age (

=0.001)

a lower proportion of MCS patients (

=0.001)

a lower CRS-R score (

0.001)

a longer ICU stay (

0.001)

and a higher proportion of paroxysmal sympathetic hyperexcitability syndrome (PSH). Multivariate analysis indicated that age (

=1.316

=0.006)

CRS-R score (

=0.200

=0.037)

ICU stay time (

=3.991

=0.040) and PSH symptoms (

=11.874

=0.040) were major influencing factors for abnormal hormone levels.

Conclusion

The pDOC patients have a high proportion of abnormal pituitary hormones

which is positively correlated with CRS-R score of patients' consciousness level. ICU stay time and PSH symptoms are risk factors of abnormal pituitary hormones.

关键词

Keywords

references

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