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目的:探讨促肾上腺皮质激素(ACTH)、皮质醇(COR)和血糖对弥漫性轴索损伤(DAI)预后判断的临床意义。方法:选择DAI患者70例,根据头颅MRI显示的病灶范围分为轻型组、中型组和重型组,同时选择体检健康者23例作为对照,观察各组ACTH、COR和血糖变化情况。结果:ACTH、COR和血糖水平DAI轻、中和重型组均明显高于对照组(P<0.05),其中重型组ACTH、COR和血糖水平最高,分别为(8.84±2.67)mmol·L~(-1)、(35.18±12.17)μg·dl~(-1)和(64.28±23.18)pg·ml~(-1),其次为中型组,对照组ACTH、COR和血糖水平最低。DAI患者在治疗后第3天时血糖和ACTH较入院第1天有所降低,COR在治疗后第5天时较入院第1天有所降低,血糖在入院后持续下降(P<0.05)。预后良好者伤后6个月ACTH、COR和血糖水平分别为(31.07±11.17)pg·ml~(-1)、(17.11±8.49)μg·dl~(-1)和(4.67±0.88)mmol·L~(-1),明显低于预后不良者(P<0.05);血糖和ACTH判断预后ROC曲线下面积为0.886和0.861(P<0.05),而COR判断预后ROC曲线下面积为0.638(P>0.05);血糖和ACTH判断预后的截止点分别为5.30 mmol·L~(-1)和36.05 pg·ml~(-1)。结论:监测血清ACTH、COR以及血糖浓度对DAI病情轻重、治疗效果和预后的判断有一定的临床意义,其中血清ACTH和血糖浓度的判断价值较高。
Objective: To investigate the clinical significance of adrenocorticotropic hormone (ACTH), cortisol (COR) and blood glucose in the prognosis of diffuse axonal injury (DAI). Methods: Seventy patients with DAI were selected and divided into light group, medium group and heavy group according to the lesion range of head MRI. At the same time, 23 healthy subjects were selected as control group, and the changes of ACTH, COR and blood glucose in each group were observed. Results: The levels of ACTH, COR and glucose in DAI group were significantly higher than those in control group (P <0.05), and the levels of ACTH, COR and blood glucose were the highest in severe group (8.84 ± 2.67 mmol·L ~ (35.18 ± 12.17) μg · dl -1 and (64.28 ± 23.18) pg · ml -1, respectively, followed by the middle group. The levels of ACTH, COR and blood glucose in the control group were the lowest. In DAI patients, the blood glucose and ACTH decreased on the 3rd day after treatment and the COR decreased on the 5th day after treatment compared with the first day after admission. The blood glucose decreased continuously after admission (P <0.05). The levels of ACTH, COR and blood glucose in the patients with good prognosis were (31.07 ± 11.17) pg · ml -1, (17.11 ± 8.49) μg · dl -1 and (4.67 ± 0.88) mmol · L -1, significantly lower than those with poor prognosis (P <0.05). The area under the ROC curve was 0.886 and 0.861 respectively (P0.05), while the area under the ROC curve was 0.638 P> 0.05). The cutoff points of blood glucose and ACTH were 5.30 mmol·L -1 and 36.05 pg · ml -1, respectively. Conclusion: It is of clinical significance to monitor the serum ACTH, COR and blood glucose concentration in determining the severity of DAI, the therapeutic effect and the prognosis. The serum ACTH and blood glucose levels are of high value.