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目的探讨急性一氧化碳中毒后迟发性脑病(DEACMP)患者血清促肾上腺皮质激素释放激素(CRH)水平的变化及其临床意义。方法应用酶联免疫吸附法动态测定33例DEACMP患者血清CRH水平,并与32例急性一氧化碳中毒(ACMP)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 DEAC-MP组急性期血清CRH水平明显高于正常对照组(P<0.05),与ACMP组急性期比较无显著差异(P>0.05);AC-MP组急性期明显高于正常对照组(P<0.05)。DEACMP组恢复期血清CRH水平明显低于急性期(P<0.05),但仍明显高于ACMP组随访期和正常对照组(均P<0.05);ACMP组随访期血清CRH水平明显低于急性期(P<0.05),与正常对照组比较无显著差异(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<0.05)。DEACMP组急性期、恢复期患者血清CRH水平变化与HDS评分变化之间呈显著正相关性(P<0.05)。结论下丘脑-垂体-肾上腺皮质轴参与了DEACMP的发病机制,CRH的水平变化与病情变化基本一致。
Objective To investigate the changes of serum corticotropin-releasing hormone (CRH) level and its clinical significance in patients with delayed cerebral encephalopathy (ACAC) after acute carbon monoxide poisoning. Methods Serum levels of CRH in 33 patients with DEACMP were measured by enzyme-linked immunosorbent assay (ELISA), and compared with those of 32 patients without DEACMP after 32 patients with acute carbon monoxide poisoning (ACMP). The daily living ability scale (ADL) , Common sense - memory - attention test (IMCT), Hasegawa dementia scale (HDS) dynamic examination of DEACMP patients with changes in the condition. Results The level of serum CRH in acute stage of DEAC-MP group was significantly higher than that of normal control group (P <0.05), but there was no significant difference between ACAC group and ACMP group (P> 0.05). The acute phase of AC-MP group was significantly higher than that of normal control group P <0.05). The level of serum CRH in convalescent phase of DEACMP group was significantly lower than that in acute phase (P <0.05), but still significantly higher than that in ACMP group and normal control group (all P <0.05). Serum CRH level in ACMP group was significantly lower than that in acute phase (P <0.05), no significant difference compared with the normal control group (P> 0.05). The levels of ADL, HDS and IMCT in acute phase of DEACMP group were significantly different from those in convalescence phase (all P <0.05). There was a significant positive correlation between serum CRH levels and HDS score in acute and convalescent DEACMP patients (P <0.05). Conclusions The hypothalamic-pituitary-adrenocortical axis is involved in the pathogenesis of DEACMP. The changes of CRH levels are basically the same as those of the disease.