目的：对脑血管病（ＣＶＤ）患者进行不同病程、不同病变部位下丘脑垂体肾上腺（ＨＰＡ）机能改变的观察研究。方法：应用放免分析法，对１７２例ＣＶＤ患者（脑出血６８例、脑梗死１０４例）检测血清ＡＣＴＨ、皮质醇含量。结果：急性期ＣＶＤ患者血清ＡＣＴＨ、皮质醇含量水平明显高于对照组，尤以脑出血为著，差异均有显著性（Ｐ＜０．０５～０．０１）。恢复期时，其含量水平明显下降，但仍高于对照组，差异有显著性（Ｐ＜０．０５）。不同病变部位ＣＶＤ时，血清ＡＣＴＨ、皮质醇含量不同，呈现丘脑＞基底节＞脑叶的趋势。结论：ＣＶＤ时，随病程延长、病症好转，ＨＰＡ机能紊乱具有可逆性；不同部位ＣＶＤ时ＨＰＡ机能成应激性增强；脑组织病损后神经介质变化也可能为ＨＰＡ机能改变的重要因素。 Objective: To observe the changes of function of hypothalamic-pituitary-adrenal (H-P-A) in patients with cerebrovascular disease (CVD) at different stages and at different locations. Methods: Radioimmunoassay was used to detect serum ACTH and cortisol levels in 172 CVD patients (68 with cerebral hemorrhage and 104 with cerebral infarction). Results: The levels of serum ACTH and cortisol in patients with acute phase CVD were significantly higher than those in the control group, especially for cerebral hemorrhage (P <0.05 ~ 0.01). During convalescence, its content decreased significantly, but still higher than the control group, the difference was significant (P <0.05). Different lesions of CVD, serum ACTH, cortisol levels are different, showing the trend of thalamus> basal ganglia> lobar. Conclusions: With the prolongation of the course of the disease, the symptoms are improved and the dysfunction of HPA is reversible. The HPA function of the different parts of the brain is enhanced by stress, and the neurological changes may also be H  P  A major factor in the performance change.