PATTERN OF ACTIVATION OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN ACUTE STROKE - RELATION TO ACUTE CONFUSIONAL STATE, EXTENT OF BRAIN-DAMAGE, AND CLINICAL OUTCOME
PATTERN OF ACTIVATION OF THE HYPOTHALAMIC-PITUITARY-ADRENAL AXIS IN ACUTE STROKE - RELATION TO ACUTE CONFUSIONAL STATE, EXTENT OF BRAIN-DAMAGE, AND CLINICAL OUTCOME
复制标题
DOI：
10.1161/01.str.25.6.1105
复制
发表时间：
1994-06-01
期刊：
影响因子：
8.3
通讯作者：
HENNERICI, M
中科院分区：
文献类型：
--
作者：
FASSBENDER, K;SCHMIDT, R;HENNERICI, M
背景和目的本研究的目的是表征下丘脑-垂体-肾上腺系统在缺血性脑卒中的最初几个小时内的反应，并将其与急性精神错乱状态、脑损伤量和临床结果的发生程度联系起来。方法23例患者在发病后第4、6、8、10、14小时及第1、3、5、7天检测促肾上腺皮质激素（促肾上腺皮质激素[ACTH]）和皮质醇的分泌情况。评估急性精神错乱状态（DSM-III-R标准）、病变程度（计算机断层扫描体积）以及神经和功能预后（斯堪的纳维亚卒中量表、Barthel指数评分）。结果观察到的大量神经内分泌反应包括初始阶段伴随ACTH和皮质醇水平升高，第二阶段伴随ACTH水平下降而高浓度皮质醇持续存在。急性精神错乱患者初始ACTH水平显著升高，但皮质醇水平无显著升高，且与脑损伤体积及神经功能预后显著相关。结论下丘脑-垂体-肾上腺轴的早期持续激活与疾病的严重程度有关。其特征性的双相模式表明，ACTH释放的初始中枢刺激随后是反馈抑制，并伴有肾上腺易感性的增加。由于已知这些激素会加剧神经元的缺氧损伤，它们在超急性中风中的大量释放可能会增加脑损伤的程度。
Background and Purpose The aim of this study was to characterize the response of the hypothalamic-pituitary-adrenal system in the first hours of ischemic stroke and to relate its extent to the occurrence of acute confusional state, volume of brain damage, and clinical outcome.Methods The secretion of corticotropin (adrenocorticotropic hormone [ACTH]) and cortisol was studied in 23 patients by determinations at hours 4, 6, 8, 10, and 14 and days 1, 3, 5, and 7 after onset of symptoms. Acute confusional state (DSM-III-R criteria), extent of lesion (volumetry of computed tomographic scans), and neurological and functional outcome (Scandinavian Stroke Scale, Barthel Index scores) were assessed.Results The massive neuroendocrine response observed consisted of an initial phase with concomitantly increased levels of ACTH and cortisol and a second phase with decreased levels of ACTH while high concentrations of cortisol persisted. Initial levels of ACTH but not cortisol were significantly increased in patients with acute confusional state and significantly correlated with volume of brain lesion and neurological and functional outcome.Conclusions An early and persisting activation of the hypothalamic-pituitary-adrenal axis was observed in relation to severity of disease. Its characteristic biphasic pattern suggests an initial central stimulation of release of ACTH followed by feedback suppression concomitant with an increased susceptibility of the adrenal gland. Because these hormones are known to exacerbate hypoxic injury to neurons, their massive release in hyperacute stroke may increase the extent of brain damage.