Changes Of Serum Cortisol And Serum Adreno-corticotropic Hormone And Glucose In Acute Traumatic Brain Injury

ObjectiveTo investigate the clinical significance of the changes of serum cortisol(COR), adrenocorticotropin(ACTH), and glucose in different stages after acute traumatic brain injury(TBI), and to find out the neuroendocrine alterations represented by changes of these hormones and glucose, then help to guide clinical administration of glucocorticoids(GCs) and regulate the glucose.MethodsThe reseach was carried out in Neurosurgical centers of General Hospital, Tianjin Medcal University and Huanhu Hospital in Tianjin. From August in2010to September in2011,165TBI patients with an admitting post-trauma period within24h were included in this study as test group. Patients were classified into three subgroups: mildly, moderately and severely injured groups. Twenty-three non-stress individuals were studied as contrast.ACTH and total COR were measured by a solid-phase, two-side sequential chemiluminescent immunometric assay; Glucose was measured by a glucose oxidase. Data were analyzed with SPSS17.0(measurement data using t-test, count data using χ2-test), a two-tailed P value was considered significant. COR、ACTH and glucose were compared among non-stress contrast and mild, moderate and severe TBI group, to elucidate the acute stressful reactions, dynamic changes of the hormones, meanwhile, adrenal cortex function was evaluated in these patients and the control of glucose in different prognosis groups..Results1. In165patients of this group, with24h following acute TBI, COR, ACTH, and glucose were higher than non-stress contrast(P<0.05), while hormones in severely injured group were higher than non-herniation group(P<0.05).2. In the7days post-trauma, COR, ACTH, and glucose experienced rapid elevation then decreased quickly, groups of different injury decrease in varying speeds; ACTH returned to normal level within the second day due to a short plasma half-life; COR, and glucose dropped slower, returned to normal level between day4 and day5; COR and glucose elevated in several patients with complications, but fell to normal level in2days after controlling.3.Compared with non-herniation group, COR ACTH and glucose are higher in herniation group; with the condition of injury increased, COR ACTH and glucose levels are significantly higher than normal.4. Following acute TBI, emergency craniotomy group showed higher COR ACTH and glucose levels than conservative group before operation(P<0.05). The first day after operation or trauma, no difference was observed(P<0.05). In craniotomy group, COR、.ACTH and glucose decreased(P<0.05), may related to the factors such as reducing the intracranial pressure after operation.5. COR、ACTH and glucose levels of favorable outcome group and poor outcome group experienced gradual decrease in the post-trauma period. But COR and glucose recovered to normal range on day2to day3in favorable outcome group, quicker than poor outcome group on day5.Conclusions1. Traumatic brain injury acts as an intensive stress factor, can bring about prompt activation of hypothalamic-pituitary-adrenal (HPA) axis, represented by rapidly increased serum COR, and ACTH, the increase is mostly evident in severely injured group. COR and glucose level is correlated with intensity of injury, increasing with enhanced injury severity.2. Following acute TBI, COR, ACTH, and gluocse elevate rapidly then decrease quickly, ACTH decrease rapidly to normal within the second day due to a short plasma half-life. COR, and gluocse draw back slower, return to normal between day4and5.3. With the condition of injury increased, COR ACTH and glucose levels are significantly higher in herniation group.4. Emergency craniotomy may function as another stressful factor when the body is in peak of stress, but shows no obvious augment effect on hormones reaction, on the contrary, may relieve the body from stress.5. COR levels of favorable outcome group recover to normal range quickly on day2～3, while in poor outcome group, COR return to normal range more slowly on day5; glucose return to normal range more slowly than COR about2-3days.6. The increase of the blood glucose in patients with acute traumatic brain injury is correlated with intensity of injury. The higher the blood glucose and the longer the duration of the increase in the blood glucose, the more serious of brain injury, the worse the prognosis becomes, patients die more likely.7. The levels of serum cortisol, ACTH and glucose are closely related with the severity, treatment and prognosis of traumatic brain injury.