| Traumatic brain injury(TBI)is one of the leading causes of death and disability in humans.There is considerable morbidity,mortality,and disability rate associated with TBI.In the acute phase after trauma,the hypothalamic and pituitary damage is often caused by elevated intracranial pressure,ischemia,hypoxia,hematoma compression,mechanical injury,etc.,which induces anterior pituitary dysfunction with elevated or decreased hormone levels in the blood.The pituitary and target glandular hormones participate in the body’s growth and development,immune regulation,material metabolism,and a series of water and electrolyte balance regulation,which affect the circulatory system,the immune system,the metabolic system,the blood system and nervous system.Patients with hormonal abnormalities may have a series of clinical problems such as disturbance of consciousness,sleep disorders,cognitive dysfunction,hypotension,hypochloremia,and hyponatremia,which may aggravate brain damage.At present,it is not completely clear on the characteristics of pituitary hormone levels in patients with TBI,and how the pituitary hormones cause changes in peripheral blood routine parameters and biochemical indicators.Persistent plant status(PVS)is a common disturbance of consciousness after severe traumatic brain injury(s TBI).Some patients with PVS may have some abnormalities in their hormone levels in the early TBI phase.Abnormal blood routine parameters and biochemical indicators may also predict pituitary dysfunction.The currently accepted treatment is hormone replacement therapy when pituitary dysfunction,but the hormone levels needs to be monitored dynamically,and the hormonal drugs may have adverse reactions.At present,it is not clear that when the patients should be diagnosed and treatedafter the trauma.These patients with pituitary dysfunction after TBI may not receive effective diagnosis and treatment.Therefore,it is necessary to find measures to prevent hypopituitarism and related new treatments.Hyperbaric oxygen therapy(HBOT)can improve the oxygen partial pressure and oxygen storage capacity of the brain tissues,improve cerebral hypoxia-ischemic damage,and it seems theoretically feasible to promote the recovery of pituitary function by hyperbaric oxygen therapy.This study was divided into three parts: 1.To observe the changes of the pituitary hormone levels and some blood routine parameters and biochemical indicators in patients with TBI,and further explore the relationship between hormone levels and blood routine parameters and biochemical indicators after TBI,so that clinicians can detect hypopituitary dysfunction in a timely manner when peripheral blood routine and biochemical indexes are abnormal in patients with TBI,and take timely intervention measures.2.To observe the characteristics of the pituitary hormone levels in patients with PVS after early s TBI,which provides a basis for clinical intervention to improve the prognosis in the early stage after TBI;3.To observe the effects of HBOT on the pituitary functions and the quality of life in patients with hypopituitarismat the subacute stage after TBI,and looking for a new treatment for clinical treatment and prevention of post-traumatic hypopituitarism.Methods1.Changes in the hormone levels and blood routine parameters and biochemical indicators in patients with TBI: The 94 patients with the early TBI and 18 healthy examinees were continuously collected.The TBI patients were divided into mild TBI group(27 cases),moderate TBI group(20 cases),and severe TBI group(47 cases)according to the Glasgow Coma Scale(GCS)score at admission(GCS score were 13-15 points,9-12 points,and 3-8 points respectively).Peripheral blood basal hormone levels,blood routine parameters and biochemical indicators were measured in TBI patients on the 2nd,8th,and 15 th days after trauma and in healthy examinees on the next day after enrollment.The blood basal hormone levels including adrenocorticotropic hormone(ACTH),cortex alcohol(COR),growth hormone(GH),insulin like growth factor 1(IGF-1),thyroid stimulating hormone(TSH),triiodothyronine(T3),free triiodothyronine(FT3),tetraiodothyronine(T4),free tetraiodothyronine(FT4),prolactin(PRL),follicle stimulating hormone(FSH),luteotropic hormone(LH),testosterone(TES)in men,estradiol(E2)in females].The blood routine parameters contain white blood cell count(WBC),neutrophil percentage(N%),neutrophil count(N),red blood cell count(RBC),platelet count(PLT).The blood biochemical indicators contain blood urea nitrogen(BUN),creatinine(Cr),uric acid(UA),serum total protein(TP),serum albumin(ALB),serum globulin(GLB),glucose(GLU),sodium,potassium,chlorine,calcium.The characteristics of hormone levels,blood routine and biochemical indicators were compared between the TBI group and the control group,and the correlation between the hormone levels and blood routine and biochemical indicators was analyzed.2.Changes in the hormone levels in patients with PVS in the early stage after TBI.The 54 patients with early s TBI were continuously collected.Peripheral blood basal hormone levels(ACTH,COR,GH,IGF-1,TSH,T3,FT3,T4,FT4,PRL,FSH,LH,TES in men,E2 in females)were measured on the 2nd,8th,and 15 th days after trauma.Assign values to ACTH,GH,TSH,PRL,LH and FSH,and calculate the general pituitary hormone score.One month after injury,they were divided into the PVS group(20 cases)and the non-PVS(NPVS)group(21 cases)based on their coma recovery scale-revised(CRS-R)score.The changes of the hormone levels and the general pituitary hormone score were compared between the two groups.3.Effects of hyperbaric oxygen therapy on anterior pituitary function in patients with subacute TBI: The 76 patients of hypopituitarism with subacute TBI were randomly divided into the HBOT group(38 cases)and the control group(38 cases).The control group was accepted routine basic treatment and the HBOT group was accepted HBOT combined with routine basic treatment.HBOT was pressurized for 20 minutes,the pressure was 0.2 MPa(2.0 ATA),took a mask or hood(for the patients who had a tracheotomy)and sucked oxygen for 30 minutes after a stable pressure,rested for 5minutes,then sucked oxygen for 30 minutes,decompressed for 20 minutes,and the total treatment time was 105 minutes,once a day,5 times a week for 4 weeks.Serum ACTH,GH,TSH,PRL,LH,FSH,COR,IGF-1,FT4,TES in men,and E2 in female were detected in all patients before treatment and after 4 weeks of treatment.Assigned values to ACTH,GH,TSH,PRL,LH and FSH,and calculated the general pituitary hormone score in all patients before treatment and after 4 weeks of treatment.The Barthel Index(BI)was used to assessment the quality of life before and after treatment,and 3 months after treatment.Results1.The incidence of hypopituitarism in patients with TBI: The incidence of hypopituitarism in patients with TBI was 38.4%,24.7%,and 17.8% on the 2nd,8th,and15 th days after injury.The incidence of hypopituitarism in the mild TBI group and the severe TBI group(35%,43.2%)on the 2nd day was higher than that in the control group(5.6%),and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of hypopituitarism among the three groups of TBI patients at the same time point(P>0.05).2.Characteristics of the hormone levels changes in patients with early TBI: On the 2nd day,COR value of patients with mild TBI was higher than that of the control group,and ACTH,IGF-1,TSH,T3,T4,FT3,FT4,LH,and TES values were lower than those of the control group(P<0.05));COR and GH values in patients with moderate TBI were higher than those in the control group,and IGF-1,TSH,T3,T4,FT3,and TES values were lower in the control group(P<0.05);COR,GH,and E2 values in patients with severe TBI were higher than the control group,IGF-1,TSH,T3,T4,FT3,FT4,LH,TES values were lower than the control group(P<0.05).On the 8th day,COR and GH values in the mild TBI group were higher than those in the control group,and T3,T4,FT3,FT4,and TES values were lower in the control group(P<0.05);COR,GH,and E2 values in the moderate TBI group were higher than the control group.T3,FT3,FSH,and TES values were lower than the control group(P <0.05);COR and GH values were higher in the severe TBI group,and IGF-1,T3,T4,FT3,FT4,LH,and TES values were lower than the control group(P<0.05).On the 15 th day,T3,FT3,LH,and TES values in the mild TBI group were lower than those in the control group,and T3,FT3,and TES values in the moderate TBI group were lower than those in the control group(P<0.05);COR and GH values were higher in the severe TBI group than in the control group.IGF-1,T3,FT3,and TES values were lower than those in the control group(P<0.05).IGF-1,T3,FT3,FT4,PRL,TES values were not all the same in different groups(P<0.05),COR,IGF-1,TSH,T3,T4,FT3,PRL,TES values are not all the same at different time points(P<0.05),hormone indexes were no cross-effect between groups and times(P>0.05).Pairwise comparison shows: PRL value(mild group <moderate group = severe group),IGF-1,T3,FF3,FT4,TES values(mild group= moderate group> severe group),COR value(D2>D8>D15),IGF-1 value(D2<D8<D15),TSH,T3,T4,FT3,TES values(D2=D8<D15),PRL valuesf(D2<D8=D15).It can be seen that COR and GH values in TBI patients were higher than the control group,and IGF-1,thyroid hormone,and TES values were lower than the control group at several time points after trauma.The changes were more obvious on the 2nd day and in the severe TBI group;the more severe the injury,the IGF-1,T3,FF3,FT4,and TES were more obvious decline.Over time,COR was gradually decreasing,and IGF-1,thyroid hormone,and TES were gradually increasing.3.Characteristics of the hormone levels changes in patients with early TBI: On the 2nd day,WBC,N%,N,and GLU in patients with mild TBI were higher than those in the control group,and RBC,PLT,UA,and calcium were lower than those in the control group(P<0.05);WBC,N%,N,and GLU in patients with moderate TBI were higher than those in the control group,and RBC,UA,and PLT were lower than those in the control group(P<0.05);WBC,N%,N,GLU,and chlorine in patients with severe TBI were higher than those in the control group In the group,RBC,PLT,UA,TP,ALB,and calcium were lower than those in the control group(P<0.05).On the 8th day,WBC,N%,and N in the mild TBI group were higher than those in the control group,and RBC,Cr,and UA were lower in the control group(P<0.05);WBC,N%,N,and potassium in the moderate TBI group were higher than the control Group,RBC,Cr,UA,calcium was lower than the control group(P<0.05);severe TBI group was higher than the control group,WBC,N%,N,GLU,potassium,WBC,N%,N,RBC,PLT,Cr,UA,TP,ALB,sodium,and calcium were lower than those in the control group(P<0.05).On the 15 th day,WBC,N%,N,and potassium of the mild TBI group were higher than those of the control group,and RBC,Cr,and UA were lower than those of the control group(P<0.05);N%,N,and potassium of the moderate TBI group were higher than the control group,RBC,PLT,Cr,UA,potassium,and chlorine were lower than the control group(P<0.05);severe TBI group was higher than the control group,WBC,N%,N,PLT,GLU,potassium,RBC,Cr,UA,TP,ALB and sodium were lower than those in the control group(P<0.05).WBC,N%,N,GLU,TP,and ALB were not all the same in different groups(P<0.05),WBC,N%,N,PLT,GLU,TP,GLB,potassium,and calcium are not the same at different time points(P<0.05),Na has a cross-effect between group and time(P<0.05).Pairwise comparison: WBC,N%,N,GLU(mild group = moderate group <severe group),RBC,TP,ALB(mild group = moderate group> severe group),COR,WBC,N%,N,GLU(D2>D8>D15),PLT(D2<D8<D15),BUN,TP,GLB,potassium,calcium(D2<D8=D15),Cr(D2>D8=D15),UA(D2=D15<D8).It can be seen that WBC,N%,N,and GLU in the TBI patients were higher than the control group at multiple time points after injury,and RBC and UA were lower than the control group.The changes were more obvious on the 2nd day and in the severe TBI group;the more severe the injury,the WBC,N%,N,and GLU were more obvious increase.Over time,WBC,N%,N,and GLU were gradually increasing,and TP was gradually diclining.4.Correlation between hormone levels and peripheral blood routine and biochemical indicators in patients with TBI: Single hormone indicator was related to multiple blood routine and biochemical indicators,and single indicator of blood routine or blood biochemical was related to multiple hormone indicators.WBC,N%,N,GLU were negatively correlated with IGF-1,TSH,T3,FT3,PRL,LH,TES,and positively correlated with COR(P <0.05);RBC was negatively correlated with GH,TSH,and IGF-1.FT4,E2 were positively correlated(P <0.05);PLT was negatively correlated with COR,and positively correlated with ACTH,GH,IGF-1,TSH,T3,T4,FT3,and LH(P <0.05);potassium and IGF-1,TSH,T3,T4,FT3,PRL,LH were positively correlated and negatively correlated with COR(P <0.05);sodium was negatively correlated with GH,TSH,T4,FT3,FT4,and positively correlated with COR(P<0.05));Chlorine was negatively correlated with COR,TSH,T4,FT3,FT4.5.The changes of hormone levels and the general pituitary hormone score in PVS patients: The incidence of GH axis insufficient of the PVS group was lower than that of the NPVS group on the 2nd after injury(P<0.05).COR,IGF-1,T3,T4,FT3,TSH,PRL,FSH,TES values,and the general pituitary hormone score were not all the same at different time points(P<0.05),all indexs did not have a cross-effect between group and time(P>0.05).Pairwise comparison the relationship: COR value was D2>D8=D15,IGF-1,TSH,T4 values,and the general pituitary hormone score were D2<D8<D15,T3 and FT3 values were D2=D8<D15,PRL value was D2<D8=D15,FSH value was D8<D2<D15,and TES value was D2=D8<D15.It can be seen that T3,T4,FT3,TES values in the PVS group is lower than the NPVS group.The COR value is higher and the other hormones levels were lower in the early stage.Over time,COR value decreased within 15 days after injury,and the other hormone levels increased to some degrees.6.Effects of HBOT on pituitary function,the general pituitary hormone score,and the BI score: The LH level and the BI score of HBOT group were higher than those of the control group(P <0.05).The PRL level,the TES level and the BI score after treatment were all higher than before treatment(P <0.05).The increase of the PRL level,the TES level,the general pituitary hormone score,and the BI score were higher in the HBOT group than those in the control group,and the rate of changes were higher than those in the control group(P <0.05).7.Correlation between the BI scores and the hormone levels: The BI scores in the HBOT group and the control group after treatment were positively correlated with PRL,LH,TES,and the general pituitary hormone scores in the two groups after treatment(P<0.05).The BI scores of the HBOT group and the control group were positively correlated with TES,E2,and the general pituitary hormone scores in the two groups 3months after treatment(P <0.05).Conclusions1.There is a high incidence of hypopituitarism with TBI patients in the early stage after injury.Pituitary function gradually recovers with time,some hypopituitarism still exists on the 15 th day.The incidence of GH axis insufficient is higher in PVS patients.This suggests that clinicians should take attention to the occurrence of hypopituitarism at the same time of diagnosis and treatment in patients with traumatic brain injury.2.The more severe the injury,the more obvious the changes in hormone levels,and the slower the recovery.The hormone levels of s TBI patients should be focused on,and the follow-up time should be appropriately extended.3.Changes in blood routine and blood biochemical single indexes may be affected by the combined effects of multiple hormone levels.Increased WBC,N%,N,and GLU may indicate hypopituitarism.In addition to considering cerebral salt wasting syndrome and abnormal antidiuretic hormone secretion syndrome,abnormal pituitary function should be suspected when electrolyte disorders are difficult to correct.If necessary,supplemental hormone levels should be given to treat electrolyte disorders after brain injury.4.Thyroid hormone and TES levels are low in PVS patients in the early stage after TBI.Appropriate supplementation of thyroid hormones and androgens may help improve neuroprotective effects in the early stage after TBI,reduce metabolic disorders in the body,and enhance immune regulation to improve clinical prognosis.5.If there is no contraindication for TBI patients,giving HBOT within 3 months after trauma can better improve their quality of life,and promote the recovery of pituitary function.6.During the development of the disease,the level of individual hormones has risen and fallen,and when the level of hormone changes is not obvious,it is difficult to reflect the overall function of the pituitary gland with a single indicator,while the general pituitary hormone score comprehensively evaluates six pituitary hormones,which can be more fully reflected the functional status of the pituitary gland,and can be used for clinical evaluation pituitary function. |
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