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題 名 | Hypothalamic Dysfunction in Acute Head-Injured Patients with Stress Ulcer=頭部外傷有壓力性潰瘍患者可能合併下視丘損傷 |
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作 者 | 黃旭霖; 劉安祥; 洪純隆; 謝建勳; 黃宗人; | 書刊名 | The Kaohsiung Journal of Medical Sciences |
卷 期 | 14:9 1998.09[民87.09] |
頁 次 | 頁554-560 |
分類號 | 416.21 |
關鍵詞 | 頭部外傷; 壓力性潰瘍; 下視丘損傷; Head injury; Stress ulcer; Hypothalamus; |
語 文 | 英文(English) |
中文摘要 | 嚴重頭部外傷的患者,已有許多文獻報告可能伴隨下視丘腦垂體的損傷,另外, 頭部外傷的患者也常出現壓力性腸胃潰瘍,然而,頭部外傷併壓力性潰瘍的患者,其血液腦 垂體荷爾蒙的變化則甚少文獻提及。本研究包括四十個頭部外傷的男性患者,以內視鏡觀察 是否有壓力性潰瘍發生,全部患者抽血檢查腦垂體荷爾蒙包括:甲狀腺激素(TSH),激乳素 (PRL),生長激素(GH)黃體激素(LH),和卵泡激素(LSH),並比較兩組患者(壓力性潰瘍有或無) 的荷爾蒙濃度差異。進入研究的患者需先符合下述條件:1)Glasgow昏迷指數4至10;2)頭部 外傷24小時內,至醫院時無休克或無敗血症現象。40位患者中有27位(67.5%)證實有壓力 性潰瘍。無壓力性潰瘍組的患者,血液中TSH,PRL,GH,LH和FSH濃度皆正常;而有壓力性 潰瘍組的患者PRL異常昇高,和無壓力性潰瘍組比較,其統計學的差異(p<0.001)。TSH和GH 在有壓力性潰瘍組明顯降低,也具有統計上的意義(p<0.001)。在有壓力性潰瘍組患者,施予 甲狀腺激素刺激荷爾蒙(TRH)和生殖激素刺激荷爾蒙(GnRH),可見TSH,PRL,LH,FSH呈有意 義的昇高(p<0.001)。由上述研究可知,頭部外傷併壓力性潰瘍患者,可能有下視丘-腦垂體 區的損傷。在壓力性潰瘍組中,由腦垂體荷爾蒙異常以及對刺激反應呈荷爾蒙昇高,可知這 些患者荷爾蒙異常可能和下視丘損傷有關。 |
英文摘要 | In patients with severe head injury, hypothalamohypophyseal impairment with sub- sequent hormone abnormalities has been well documented. Stress ulcer is another commonly encountered problem in such patients. However, little has been reported in the literature about the alterations of pituitary hormones in acute head-injured patients with stress ulcer. Forty consecutive male patients with head injury were studied. The other criteria for eligibility were: (1) Glasgow coma scale 4 to 10; (2) within 24 hours after head injury; (3) not in shock or sepsis; and (4) no past history of peptic ulcer. Stress ulcer was confirmed by endoscopic examination. The basal serum levels of pituitary hormones were measured and the response of pituitary to the provocative testing with thyrotropin-releasing hormone and gonadotropin-releasing hormone was also evaluated. Twenty-seven (67.5%) of forty patients showed evidence of stress ulcer by endoscope. In the patients without stress ulcer, the basal serum levels of thyroid-stimulating hormone (TSH), prolactin (PRL), growth hormone (GH), luetinizing hormone (LH), and follicle-stimulating hormone (FSH) were found to be within normal range. However, the basal levels of PRL in the patients with stress ulcer were abnormally elevated and significantly higher than those in the patients without stress ulcer (p<0.00l). The basal levels of TSH and GH were significantly lower in the patients with stress ulcer than those without stress ulcer (p<0.001). In the patients with stress ulcer, significant increases (p<0.00l) of serum levels of TSH, PRL, LH and FSH after thyrotropin-releasing hormone (TRH) and gonadotropin-releasing hormone (GnRH) provocation were identified. Hypothalamohypophyseal dysfunction and stress ulcer may occur in severely head-injured patients. In patients with stress ulcer, the abnormalities of pituitary hormones and provocative response of the pituitary with TRH and GnRH revealed normal pituitary function with hypothalamic insufficiency. Our study suggested that stress ulcers in acute head-injured patients were associated with hypothalamic damage. |
本系統中英文摘要資訊取自各篇刊載內容。