甲亢与血皮质醇和促肾上腺皮质激素含量水平的研究

Relationship between hyperthyroidism and serum cortisol and adrenocorticotropic hormone levels

目的探讨甲状腺功能亢进症(简称甲亢)与血皮质醇(COR)、促肾上腺皮质激素(ACTH)含量水平的关系。方法选取2017年6月至2018年6月浙江省长兴县中医院诊治的135例甲亢患者作为研究对象。将这135例患者设为观察组,并根据基础代谢率将其分为轻度、中度和重度甲亢者;同时,选择同期进行健康体检者30例设为对照组。检测两组研究对象甲状腺功能和肾上腺皮质功能相关指标,分析血中COR、ACTH含量与甲亢严重程度之间的相关性。在观察组患者甲状腺功能正常后,进行小剂量地塞米松抑制试验,比较用药前后COR、ACTH含量变化情况。结果与对照组研究对象相比,观察组患者血清中总三碘甲状腺原氨酸(TT3)、总四碘甲状腺原氨酸(TT4)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)含量均有显著升高,差异具有统计学意义(P<0.05),促甲状腺激素(TSH)含量显著降低,其差异均具有统计学意义(P<0.05)。与对照组相比,观察组患者血清中COR、ACTH含量均有显著降低,其差异均具有统计学意义(均P<0.05);醛固酮(ALD)含量无显著变化,其差异无统计学意义(P>0.05)。观察组不同严重程度甲亢患者COR、ACTH含量存在显著性差异,关系为轻度组>中度组>重度组,其差异均具有统计学意义(均P<0.05);相关性分析发现,COR、ACTH含量水平与甲亢严重程度均呈负相关(r=-0.775,P<0.001;r=-0.823,P<0.001);小剂量地塞米松口服治疗后,不同严重程度甲亢患者血中COR、ACTH含量均有显著降低,且重度甲亢患者下降更为显著,其差异具有统计学意义(P<0.05)。结论甲亢严重程度与COR、ACTH含量呈负相关,且重度甲亢患者可能会损伤肾上腺皮质功能。

Objective To investigate the relationship between hyperthyroidism and serum cortisol(COR),adrenocorticotropic hormone(ACTH)levels.Methods A total of 135 hyperthyroidism patients in Changxing County Hospital of Traditional Chinese Medicine from June 2017 to June 2018 were enrolled as the observation group.According to basal metabolic rate,they were divided into mild,moderate and severe hyperthyroidism patients.30 people who underwent healthy physical examination in the same period were enrolled as the control group.The thyroid function and adrenal cortical function related indexes in both groups were measured.The correlation of serum COR and ACTH levels with the severity of hyperthyroidism was analyzed.Low-dose dexamethasone suppression test was performed after thyroid function got normal in observation group.The changes in COR and ACTH contents between before and after medication were compared.Results Compared with the control group,contents of serum total triiodothyronine(TT3),total thyroxine(TT4),free triiodothyronine(FT3)and free thyroxine(FT4)were significantly increased in the observation group(P<0.05),while content of thyroid stimulating hormone(TSH)was significantly decreased(P<0.05).Compared with the control group,contents of serum COR and ACTH were significantly decreased in the observation group(all P<0.05).There was no significant change in aldosterone(ALD)content(P>0.05).There were significant differences in COR and ACTH contents among hyperthyroidism patients with different severity in the observation group.The above indexes were the highest in mild patients,followed by moderate and severe patients(all P<0.05).Correlation analysis found that contents of COR and ACTH were negatively correlated with the severity of hyperthyroidism(r=-0.775,P<0.001,r=-0.823,P<0.001).After oral administration of low-dose dexamethasone,contents of COR and ACTH in hyperthyroidism patients with different severity were significantly decreased,and more significant in patients with severe hyperthyroidism,with statistically significant differences(P<0.05).Conclusions The severity of hyperthyroidism is negatively correlated with contents of COR and ACTH,and patients with severe hyperthyroidism may impair adrenal cortical function.