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目的了解甲状腺功能亢进症 (简称甲亢 )患者肾上腺皮质功能的变化 ,为临床治疗提供理论依据。方法通过对比正常人、轻度及重度甲亢患者肾上腺皮质对小剂量促肾上腺皮质激素(ACTH)刺激的反应 ,判断其肾上腺皮质功能状态。结果 3组患者在无应激状态下肾上腺皮质功能差异无显著性 ,但对小剂量ACTH刺激的反应不同 ,对照组及轻度甲亢组反应一致 ,皮质醇增加明显 ,重度甲亢组反应显著降低 ,皮质醇增加不明显 ,经完全随机设计的单因素方差分析 ,各时点及AUC在 3组之间差异有显著性 (15、30、6 0、90min及AUCF值分别为 2 78 3、2 74 2、4 6 9 8、2 73 3、86 6 2 ,P <0 0 0 1) ,再经最小显著差异法 (LSD t检验 )进行两两比较 ,重度甲亢组与对照组及轻度甲亢组比较差异均有显著性 (P <0 0 0 1) ,而对照组及轻度甲亢组比较差异均无显著性 (P >0 0 5 )。结论重度甲亢患者肾上腺皮质应激能力显著降低 ,可能是甲状腺危象发生的病理生理基础。
Objective To understand the changes of adrenocortical function in patients with hyperthyroidism (Hyperthyroidism), and to provide a theoretical basis for clinical treatment. Methods The adrenocortical function was evaluated by comparing the response of adrenal cortex to ACTH stimulation in normal subjects, patients with mild and severe hyperthyroidism. Results There was no significant difference in the function of adrenal cortex between the three groups under stress, but the response to low dose ACTH stimulation was different. The responses of the control group and mild hyperthyroidism group were consistent, the cortisol increased significantly, the response of severe hyperthyroidism group was significantly reduced, Cortisol increased insignificantly. After a completely randomized one-way ANOVA analysis, there were significant differences among the three groups at each time point and AUC (15,30,6 0,90 min and AUCF values were 2 78 3,2 74 2,4 6 9 8,2 73 3,86 6 2, P 0 01), and then compared with each other by least significant difference (LSD t test), severe hyperthyroidism group and control group and mild hyperthyroidism group (P <0.01), while there was no significant difference between the control group and mild hyperthyroidism group (P> 0.05). Conclusion Severe hyperthyroidism patients with adrenal cortical stress significantly reduced, may be the pathophysiology of thyroid crisis.