脑血流动力学定量评估甲状腺激素水平对脑功能的影响

Cerebral hemodynamic changes for evaluating the effect of thyroid hormone on brain function

目的:探讨甲状腺功能亢进症患者治疗前后的脑血流动力学变化与甲状腺激素变化水平的关系。方法:选择2002-03/2004-08解放军第二炮兵装备研究院门诊部和第二炮兵总医院神经内科门诊及住院的甲状腺功能亢进症患者68例,男10例,女58例;年龄16～59岁,病程1～3年。在抗甲状腺药物或放射性131I治疗前后行经颅多普勒超声检查。检测参数及异常判定标准:①平均血流速度和搏动指数,检测结果超过正常珔x±2s定为异常。②判定有无血管杂音及杂音性质:噪声性杂音音质粗糙,杂音信号出现的同时频谱表现为对称分布在基线两侧的簇状高声强信号,信号出现时间大致与收缩期同步。乐性杂音音质高尖,伴高流速。结果:按意向处理分析,68例患者全部进入结果分析。①治疗前63例(93%,63/68)血流速度增快,53例(77%,53/68)搏动指数增高。40例(58%,40/68)伴有血管杂音。②治疗后游离三碘甲状腺原氨酸、游离甲状腺素、平均血流速度、搏动指数比治疗前明显降低犤(6.3±1.3),(23.6±11.5)pmol/L;(18.4±4.7),(112.8±15.2)pmol/L;(67.6±11.4),(90.7±16.6)cm/s;(0.76±0.11),(0.95±0.02)(t=5.4～14.2,P<0.01)犦。结论:经颅多普勒超声检查显示甲状腺功能亢进症患者脑血流异常改变的脑功能障碍与甲状腺激素分泌过多有关。

AIM:To study the association between the cerebral hemodynamic changes and the changes of thyroid hormone levels in patients with hyperthyroidism before and after treatment. METHODS:Totally 68 patients with hyperthyroidism admitted to the Outpatient Department of Equipment Research Institute of Second Artillery and the Neurology Department of General Hospital of Second Artillery from March 2002 to August 2004 were selected.Among them,10 were male,58 were female,16- 59 years of age,and the course of diseases was 1- 3 years.The transcranial Doppler was used before and after the treatment of antithyroid drug or radioactive 131I.The detection parametes and abnormal criteria:① The mean flow velocity of blood and pulsitive index exceeding <IMG SRC='IMAGE/06200051.JPG' HEIGHT=8 WIDTH=4>± 2s was considered as abnormal;② The judgment of existence of vascular murmu and the characters:vocal quality of noise was raspy;the spectrum indicated loud strong signal distributed in both base lines symmetrically as soon as souffle emerged;the emergence time of signal and systole was same;the vocal quality of musical souffle was high and reedy combined with high flow velocity. RESULTS:According to intention to treat,all 68 patients were involved in the result analysis.① The flow velocity increased in 63 cases (93% ,63/68);the pulsitive index increased in 53 cases(77% ,53/68) and vascular souffle appeared in 40 cases(58% ,40/68) before treatment.② The free triiodothyronine lavel,free thyroxin level,mean flow velocity and pulsitive index decreased after treatment as compared with those before treatment[(6.3± 1.3),(23.6± 11.5) pmol/L;(18.4± 4.7),(112.8± 15.2) pmol/L;(67.6± 11.4),(90.7± 16.6) cm/s;(0.76± 0.11),(0.95± 0.02)](t=5.4- 14.2,PCONCLUSION:The ranscranial Doppler indicates that the abnormality of cerebral blood flow is closely correlated with thethyroid hormone hypersecretion in patients with hyperthyroidism.The thyroxin level can reduce and the cerebral blood flow can return to the normal after treatment.