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目的:探讨急性脑血管病(ACVD)患者甲状腺激素及皮质醇变化的机制及临床意义。方法:应用放射免疫方法对62例ACVD患者进行急性期及恢复期血清甲状腺激素及皮质醇测定。结果:①62例ACVD患者血清T_3明显有低于对照组(P<0.001),rT_3及皮质醇显著高于对照组(P<0.001),而T_4及TSH与对照组比较变化不明显(P>0.05);②ACVD重度受损组T_3及T_3/rT_3显著低于轻中度受损组(P<0.05),呈显著负相关,而rT_3及皮质醇显著高于轻中度受损组(P<0.01),呈显著正相关;③ACVD病变临近中线接近丘脑者T_3及T_3/rT_3显著低于皮层等部位病变者(P<0.05),而rT_3及皮质醇显著高于皮层等部位病变者(P<0.01);④ACVD急性期功能缺损程度越重者,T_3/rT_3及皮质醇变化越明显,预后不良;⑤随着病情恢复,T_3及T_3/rT_3明显升高(P<0.01),而rT_3及皮质醇明显降低(P<0.05),而T_4及TSH无明显改变(P>0.05)。结论:ACVD后机体的保护性应激性反应等直接或间接引起下丘脑——垂体功能改变,可能是T_3、T_3/rT_3降低,而rT_3及皮质醇升高的主要原因,可把T_3/rT_3及皮质醇值作为判断病情、估计预后的主要指标。
Objective: To investigate the mechanism and clinical significance of thyroid hormone and cortisol in patients with acute cerebrovascular disease (ACVD). Methods: Serum thyroid hormone and cortisol were measured in 62 ACVD patients by radioimmunoassay in acute and convalescent phase. Results: (1) Serum T_3 in 62 ACVD patients was significantly lower than that in control group (P <0.001), rT_3 and cortisol were significantly higher than those in control group (P <0.001), while T_4 and TSH were not significantly different from those in control group ); (2) The levels of T_3 and T_3 / rT_3 in severely damaged ACVD group were significantly lower than those in mild to moderate impaired group (P <0.05), but negatively correlated with rT_3 and cortisol (P <0.05); ③The T_3 and T_3 / rT_3 of the ACVD lesion in the midline near the thalamus were significantly lower than those in the cortex and other parts of the lesion (P <0.05), while rT_3 and cortisol were significantly higher than those in the cortex and other sites (P <0.01); (3) The levels of T_3 and T_3 / rT_3 were significantly increased (P <0.01), while the levels of rT_3 and cortisol (P <0.05), but there was no significant change in T 4 and TSH (P> 0.05). CONCLUSIONS: Protective stress response to ACVD directly or indirectly causes functional changes of hypothalamus-pituitary, which may be the result of decrease of T_3 and T_3 / rT_3, and the main reason for the increase of rT_3 and cortisol, such as T_3 / rT_3 And cortisol value as a judgment of the disease, the main prognostic indicators.