老年慢性肺心病的甲状腺功能变化

THE CHANGES OF THYROID FUNCTION IN ELDERLY PATIENTS WITH CHRONIC CORPULMONALE

本文用放免法测定了34例老年慢性肺心病患者的甲状腺激素水平,以探讨老年慢性肺心病人的甲状腺功能状态。结果发现,老年慢性肺心病组血清的TT_3、TT_4均值明显低于健康对照组(p<0.01),而TSH均值二者比较无明显差异。急性发作期组TT_3、TT_4明显下降,尤以TT_3明显,分别为1.04±0.37(nmol/L)和95.83±36.58(nmol/L),缓解期组T_3、T4_均有回升,分别为1.58±0.61(nmol/L)和105±26.66(nmol/L),说明肺心病T_3、T_4下降与肺心病的严重程度有关。急性发作期组TSH与缓解期组及健康人组比较则无明显差异,说明老年肺心病患者的甲状腺功能有一定程度减退。而TSH测定正常,能排除原发性甲状腺功能减退所致的T_3、T_4改变,符合低T_3综合征,提示下丘脑的保护性适应。动态观察血清T_3、T_4的变化,对于判断治疗和预后有一定的价值。

In order to study the thyroid function in elderly patients with chronic cor pulmonale, the serum levels of thyroid hormones were determined with radioimmuno assay (RIA) in 34 cases.The results showed that the average levels of serum T3 and T4 in this group were significantly lower than those in normal group(p<0.01), especially during acute exacerbation. However, the patients did not show any alteration in the average level of thyroid stimulation hormone(TSH).This suggested that thyroid hormones levels were related to the severity of cor pulmonale and some degree of hypothyroidism was present in patients with elderly chronic cor pulmonale. The decrease of T3 with absence of a TSH response probably resulted from an thalamic adaptive mechanism to the illness to decrease oxygen consumption and catabolic processes.Itwas beneficial for the patient to recover from the illness.We therefore considered that the changes of serum T3 and T4 levels did play an important role in prediction of the effect of treatment.