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甲巯咪唑和地塞米松对Graves甲亢患者白细胞糖皮质激素受体、血浆ACTH及皮质醇的影响

Effect of Methimazole and Dexamethasone on Leucocyte Glucocorticoid Receptor,Plasma ACTH,and Cortisol Levels in Graves′Disease

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【作者】 高勇义张存泓李秀钧

【Author】 Gao Yongyi;Zhang Cunhong;Li Xiujun (Division of Endocrinology,The First Affiliated Hospital (Chengdu 610041)

【机构】 海南省人民医院内分泌科

【摘要】 研究了32例Graves甲亢(甲亢)患者单用甲巯咪唑及联用地塞米松(Dex)治疗前后白细胞糖皮质激素受体(GCR),血浆皮质醇(PTC)和血浆ACTH的变化。开始甲巯咪唑40mg/d,两周后减至20mg/d,直至完全缓解。联用Dex组除甲巯咪唑外,开始加Dex6mg/d,第5日减至4.5mg/d,两周后减至2.25mg/d,直至完全缀解。结果发现,未治甲亢患者的白细胞GCR水平显著降低,PTC略降、ACTH轻度升高,提示甲亢时垂体-肾上腺轴机能处于代偿状态。单用甲巯咪唑组治疗后病情缓解,GCR、ACTH及PTC恢复正常。联用甲巯咪唑及Dex组治疗后,GCR、ACTH及PTC均显著降低,揭示GCR呈下降调节,同时垂体-肾上腺轴受外源性Dex抑制。因此,甲亢患者使用糖皮质类固醇治疗时应注意调整剂量,以避免由于垂体-肾上腺轴受抑制在应激时发生肾上腺皮质功能不全。

【Abstract】 Thirty-two cases of newly diagnosedGraves’disease with hyperthyroidism were recruited inthis study on the changes of leucocyte glucocorticoidreceptor(GCR),plasma ACTH,and cortisol levelshbrand after treatment with methinazole(tapazole)alone (n=16)and methimazole combined with Dexam-ethasone(bex,TD group,n=16).Twenty normalsserved as the control.Methimazole treatment was initiated with a dosage of 40 mg/d,tapered to 20 mg/d after twoweeks and maintained until complete remission in bothgroups. Meanwhile, Dex 6 mg/d was added to the TDgroup along with methimazole from the commence-ment of therapy. The dosage of bex was reduced to4.5mg/d on the 5th day and to 2.25 mg/d two weeksafter treatment, and continued until remission.It wasfound that there was remarkable decrease in leucocyteGCR levels with a moderate elevation of plasmaACTH and a slight decline of plasma cortisol in un-treated Graves’disease,suggestive of a compensationof the pituitary-adrenal axis function in hyperthy-roidism. The levels of GCR,ACTH and cortisol re-turned to normal after complete ren1ission by methima-zole in the methimazole alone group. In the TD group,however.all GcR .ACTH and cortisol levels weresignificantly decreased after Dex therapy implyingdown regulation of GCR by exogenous Dex and sup-presion of the pituitary-adrenal axis. Thus the dosageof glucocorticoid should be appropriately adjusted toavoid adrenal insufficiency,especiall y in case ofstress,due to the suppresion of pituitary adrenal func-tion.

  • 【文献出处】 华西医科大学学报 ,JOURNAL OF WEST CHINA UNIVERSITY OF MEDICAL SCIENCES , 编辑部邮箱 ,1996年01期
  • 【分类号】R581.1
  • 【被引频次】5
  • 【下载频次】91
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