关键词: 希恩综合征, 垂体危象, 精神异常, 糖皮质激素, 钠离子, 影响因素分析

Abstract: Background　It is reported that mental disorders occur in some Sheehan's Syndrome（SS）patients during treatment，which is more prevalent in those with pituitary crisis，bringing difficulties to further treatment．At present，there are few studies on the influencing factors of mental disorders in patients with SS and pituitary crisis．Objective　To investigate the influencing factors of mental disorders in SS patients with pituitary crisis during treatment．Methods　A total of 47 SS patients with pituitary crisis from the Affiliated Hospital of Zunyi Medical University were enrolled from January 2010 to August 2019，and were divided into psychiatric symptoms group（PS group，n=20）and normal psychiatric symptoms group（NPS group，n=27）by the prevalence of mental disorders．Blood pressure，height and body weight，calculated BMI，and levels of parameters 〔hemoglobin，serum sodium ion，glucose，free triiodothyronine，free thyroxine，thyroid stimulating hormone，follicular hormon，luteinizing hormone，prolactin，estradiol，growth hormone，adrenocorticotropic hormone（ACTH）and cortisol〕 in the blood sample withdrawn from forearm veins，blood lipid parameters（total cholesterol and triglyceride ）in the fasting peripheral venous blood sample were collected．The dosage of hydrocortisone（HC）in the first 24 hours of treatment and the dosage of HC before the mean occurrence time of mental disorders were also collected．Binary Logistic regression was used to explore the influencing factors of mental disorders．ROC analysis was conducted to evaluate the values of serum sodium ion，HC in the first 24 hours of treatment and the combination of them in predicting mental disorders．Results　Compared with NPS group，the mean levels of systolic blood pressure and serum sodium ion in PS group were significantly decreased（P<0.05），but ACTH HC in the first 24 hours of treatment and the mean dosage of HC before the mean occurrence time of mental disorders were significantly increased（P<0.05）．Binary Logistic regression analysis showed that HC in the first 24 hours of treatment〔OR=1.066，95%CI（1.006，1.130）〕 and serum sodium ion〔OR=0.848，95%CI（0.761，0.945）〕were associated with mental disorders（P<0.05）．For predicting mental disorders，the AUC of HC in the first 24 hours of treatment was 0.756〔95%CI（0.614，0.897），P<0.01〕，with 0.750 sensitivity and 0.667 specificity when the optimal cutoff value was chosen as 135.0 mg．The AUC of serum sodium ion level was 0.744〔95%CI（0.599，0.890），P<0.01〕，with 0.741 sensitivity and 0.700 specificity when the optimal cutoff value was chosen as 119.6 mmol/L．And the AUC of the combination of these two indicators was 0.855〔95%CI（0.748，0.961），P<0.01〕，and the sensitivity and specificity were 89.9% and 65.0%，respectively．Two cases received 350 mg HC in total but without mental disorders，the first 100 mg was administered within four hours before admission，and the remaining 350 mg was administered by slow intravenous drip infusion within 20 hours after admission Conclusion　Higher dose of HC in the first 24 hours of treatment and lower level of serum sodium ion may increase the risk of mental disorders in SS patients with pituitary crisis．Starting with a small dose of hormone and controlling the rate of administration may reduce the risk of mental disorders．

Key words: Sheehan's syndrome, Pituitary crisis, Psychiatric symptoms, Glucocorticoid, Sodium ion, Root cause analysis