神经危重症患者血、脑脊液中垂体前叶激素的变化。

TouchREVIEWS in endocrinology Pub Date : 2022-06-01 Epub Date: 2022-06-13 DOI:10.17925/EE.2022.18.1.71
Henriette Beyer, Nicole Lange, Armin H Podtschaske, Jan Martin, Lucia Albers, Alexander von Werder, Jürgen Ruland, Gerhard Schneider, Bernhard Meyer, Simone M Kagerbauer, Jens Gempt
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引用次数: 0

摘要

背景:血液中垂体前叶激素遵循昼夜节律,可能受到颅内病理等多种因素的影响。在脑脊液(CSF)中,垂体激素仅被选择性地收集,昼夜节律尚未被调查。本初步研究分析了神经危重症患者垂体前叶激素的日变化,以确定这些患者是否存在昼夜节律性。颅内病变可能的影响也进行了探讨。同时评估血液和脑脊液浓度,以探讨血液浓度作为脑脊液水平的替代参数的价值。方法:20例非镇静患者于06:00、中午、18:00和午夜采集血液和脑脊液,分析促肾上腺皮质激素(ACTH)、皮质醇、促甲状腺激素(TSH)和胰岛素样生长因子-1 (IGF-1)浓度。采用夹心化学发光免疫法检测ACTH和IGF-1。电化学发光免疫法测定皮质醇和TSH。结果:结果显示昼夜节律不一致。不到50%的患者表现出ACTH、皮质醇、TSH或IGF-1的昼夜节律性。日变化的意义只存在于血液中TSH浓度。皮质醇和TSH在血液和脑脊液浓度之间的相关性很强。结论:部分患者脑脊液浓度仅在可测范围内。除了血液中的TSH外,没有明确的昼夜节律性。没有明显的日变化可以解释为潜在的病理或重症监护病房的干扰影响。血中皮质醇和TSH浓度可能是CSF的合适替代参数。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Anterior Pituitary Hormones in Blood and Cerebrospinal Fluid of Patients in Neurocritical Care.

Anterior Pituitary Hormones in Blood and Cerebrospinal Fluid of Patients in Neurocritical Care.

Anterior Pituitary Hormones in Blood and Cerebrospinal Fluid of Patients in Neurocritical Care.

Anterior Pituitary Hormones in Blood and Cerebrospinal Fluid of Patients in Neurocritical Care.

Background: Anterior pituitary hormones in blood follow a circadian rhythm, which may be influenced by various factors such as intracranial pathologies. In cerebrospinal fluid (CSF), pituitary hormones have been collected only selectively and circadian rhythm has not yet been investigated. This pilot study analysed diurnal variations of anterior pituitary hormones in patients in neurocritical care to determine whether circadian rhythmicity exists in these patients. Possible influences of intracranial pathologies were also investigated. Blood and CSF concentrations were assessed simultaneously to explore the value of blood concentrations as a surrogate parameter for CSF levels.

Methods: Blood and CSF samples of 20 non-sedated patients were collected at 06:00, noon, 18:00 and midnight, and analysed for adrenocorticotropic hormone (ACTH), cortisol, thyroid-stimulating hormone (TSH) and insulin-like growth factor-1 (IGF-1) concentrations at each of the four time points. ACTH and IGF-1 were measured by sandwich chemiluminescence immunoassay. Cortisol and TSH were measured by electrochemiluminescence immunoassay.

Results: Results showed inconsistent circadian rhythms. Less than 50% of the patients showed a circadian rhythmicity of ACTH, cortisol, TSH or IGF-1. Significance of diurnal variations was only present for blood concentrations of TSH. Correlations between blood and CSF concentrations were strong for cortisol and TSH.

Conclusions: CSF concentrations were only in the measurable range in some of the patients. No clear circadian rhythmicity could be identified, except for TSH in blood. Absence of significant diurnal variations could be explained by the underlying pathologies or disturbing influences of the intensive care unit. Blood concentrations of cortisol and TSH may be suitable surrogate parameters for CSF.

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