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目的探讨急性一氧化碳中毒后迟发性脑病(DEACMP)患者血清皮质醇(COR)、促肾上腺皮质激素(ACTH)水平的变化及其临床意义。方法采用酶联免疫吸附法动态检测33例DEACMP患者血清COR、ACTH的水平,并与32例急性一氧化碳(CO)中毒后未发生DEACMP患者和32例正常对照者进行比较;采用日常生活能力量表(ADL)、常识-记忆-注意测验(IMCT)、长谷川痴呆量表(HDS)动态检查DEACMP患者的病情变化。结果 DEACMP组急性期血清COR水平明显高于急性CO中毒组和正常对照组(均P<0.05);ACTH水平明显高于急性CO中毒组(P<0.05),与正常对照组比较无显著差异(P>0.05)。DEACMP组恢复期血清COR、ACTH水平较急性期均有不同程度的降低,但只有COR水平有显著差异(P<0.05)。DEACMP组急性期ADL、HDS、IMCT评分与恢复期比较均有显著差异(均P<0.01)。DEACMP组急性期、恢复期血清COR水平变化与HDS和ADL评分变化之间呈显著正相关(P<0.05)。结论 DEACMP患者血清COR、ACTH水平动态变化与病情变化基本一致,动态检测血清COR、ACTH水平变化可作为DEACMP病情变化和治疗效果的生物学指标之一。
Objective To investigate the changes and clinical significance of serum cortisol (COR) and adrenocorticotropic hormone (ACTH) levels in patients with delayed encephalopathy (CAC) after acute carbon monoxide poisoning. Methods Serum levels of COR and ACTH were determined by enzyme-linked immunosorbent assay (ELISA) in 33 patients with DEACMP and compared with those without DEACMP in 32 patients with acute carbon monoxide (CO) poisoning and 32 normal controls. The daily living ability scale ADL, IMCT and HDS were used to examine the changes of patients with DEACMP. Results The level of serum COR in acute phase of DEACMP group was significantly higher than that of acute CO poisoning group and normal control group (all P <0.05). The level of ACTH in DEACMP group was significantly higher than that in acute CO poisoning group (P <0.05) P> 0.05). The levels of serum COR and ACTH in convalescent phase of DEACMP group were lower than those in acute phase, but there was significant difference only in COR level (P <0.05). The ADAC, HDS and IMCT score in acute phase of DEACMP group were significantly different from those in recovery phase (all P <0.01). There was a significant positive correlation between changes of serum COR level and changes of HDS and ADL score in acute and convalescent phase of DEACMP group (P <0.05). Conclusion The dynamic changes of COR and ACTH in serum of patients with DEACMP are basically consistent with the changes of the disease. Dynamic changes of serum COR and ACTH levels can be used as one of the biological indicators of the changes of DEACMP and the therapeutic effect.