ORIJINAL ARAŞTIRMA
Travmatik Beyin Hasarı Olan Hastalarda Travma Şiddetine Göre Fonksiyonel, Bilişsel ve Emosyonel Sonuçların ve Hipofiz Hormon Düzeylerinin Değerlendirilmesi
Evaluation of Functional, Cognitive and Emotional Outcomes and Pituitary Hormones According to Trauma Severity in Patients with Traumatic Brain Injury
Received Date : 02 Jun 2021
Accepted Date : 11 Aug 2021
Available Online : 26 Aug 2021
Nurdan KORKMAZa, Evren YAŞARa, Özge TEZENa, Tevfik SABUNCUb,
Sefa GÜMRÜK ASLANaa, Eda GÜRÇAYa
aSağlık Bilimleri Üniversitesi Ankara Gaziler Fizik Tedavi ve Rehabilitasyon Eğitim ve Araştırma Hastanesi,
Fiziksel Tıp ve Rehabilitasyon ABD, Ankara, TÜRKİYE
bHarran Üniversitesi Tıp Fakültesi, Endokrinoloji ve Metabolizma Hastalıkları BD, Şanlıurfa, TÜRKİYE
Doi: 10.31609/jpmrs.2021-84770 - Makale Dili: TR
J PMR Sci. 2022;25(2):150-7
ÖZET
Amaç: Kronik dönem orta veya ağır travmatik beyin hasarı (TBH)
olan erişkin hastalarda ön hipofiz hormon düzeylerini, fonksiyonel, bilişsel
ve emosyonel sonuçları karşılaştırmak, bu parametrelerin travma şiddeti ile
ilişkisini belirlemek hedeflenmiştir. Gereç ve Yöntemler: Kesitsel olarak
planlanan bu çalışmaya en az 6 aydır TBH’li olan 53 hasta dâhil edildi.
Travma şiddeti ilk 24 saat içinde kaydedilen Glaskow Koma Skalası (GKS)
skoruna göre belirlendi, hastalar orta (n=20) ve ağır TBH (n=33) olarak 2
gruba ayrıldı. Fonksiyonel Bağımsızlık Ölçeği (FBÖ), Mini Mental Durum
Testi (MMDT), Ranchos Los Amigos Kognitif Fonksiyon Skalası (RLAS),
Beck Depresyon Ölçeği (BDÖ) ve Beck Anksiyete Ölçeği (BAÖ) değerlendirmeler
için kullanıldı. Ayrıca tüm hastaların adrenokortikotropik hormon,
prolaktin, folikül uyarıcı hormon, luteinize edici hormon, tiroid uyarıcı
hormon, insülin benzeri büyüme faktörü-1 ve büyüme hormon bazal seviyeleri
ölçüldü. Bulgular: Orta ve ağır TBH olan hastalar arasında FBÖ,
MMDT, BDÖ ve BAÖ değerleri bakımından anlamlı farklılık vardı ancak
ön hipofiz hormon bazal düzeyleri farklılık göstermedi. GKS ile FBÖ ve
MMDT arasında pozitif ilişki, BDÖ ve BAÖ arasında negatif ilişki görülürken
ön hipofiz hormon düzeyleri ile ilişki saptanmadı. Sonuç: Kronik
TBH olan hastalarda travmanın şiddeti arttıkça günlük yaşam aktivitelerinde
bağımlılık, depresif duygudurum, anksiyete ve bilişsel işlevlerde bozulma
artmaktadır. Bu nedenle, GKS skorunun kaydedilmesi, sonraki rehabilitasyon
sürecinde, özellikle klinik sonuçların belirlenmesi açısından değerlidir.
Anahtar Kelimeler: Beyin hasarı; hipofiz hormonları; fonksiyonellik; bilişsel durum; emosyonel durum
ABSTRACT
Objective: To compare the anterior pituitary hormone levels,
functional, cognitive, and emotional outcomes in adult patients with
chronic period moderate or severe traumatic brain injury (TBI) and to determine
the relationship between these parameters and the severity of
trauma. Material and Methods: Fifty-three patients with TBI were included
in this cross-sectional study. Trauma severity was determined according to the
Glasgow Coma Scale (GCS) score recorded within the first 24 hours, and the
patients were divided into 2 groups as moderate (n=20) and severe TBI (n=33).
Functional Independence Measure (FIM), Mini Mental State Test (MMST),
Ranchos Los Amigos Cognitive Function Scale (RLAS), Beck Depression Inventory
(BDI) and Beck Anxiety Inventory (BAI) were used for evaluations.
Basal levels of adrenocorticotropic hormone, prolactin, follicle stimulating
hormone, luteinizing hormone, thyroid stimulating hormone, insulin-like
growth factor-1 and growth hormone were measured in all patients. Results:
There was a significant difference between patients with moderate and severe
TBI in terms of FIM, MMST, BDI and BAI values but no difference was found
in anterior pituitary hormone basal levels. There was a positive relationship between
GCS score and FIM and MMST, and a negative relationship between
BDI and BAI while no relationship was noted between GCS score and anterior
pituitary basal hormone levels. Conclusion: In patients with chronic TBI,
dependence in daily living activities, depressive mood, anxiety and deterioration
in cognitive functions increase as the severity of trauma increases. Therefore,
assigning the GCS score is valuable in the subsequent rehabilitation
process, especially in terms of determining clinical results.
Keywords: Brain injury; pituitary hormones; functional status; cognitive status; emotional status
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