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[甲状腺功能亢进症患者动态运动时心脏及血浆儿茶酚胺反应]

[Cardiac and plasma catecholamine response to dynamic exercise in hyperthyroidism].

作者信息

Kitamura H, Kinugawa T, Miyakoda H, Ogino K, Tomokuni A, Saito M, Hasegawa J, Kotake H, Mashiba H

机构信息

First Department of Internal Medicine, Tottori University School of Medicine, Yonago.

出版信息

J Cardiol. 1992;22(1):219-25.

PMID:1307569
Abstract

To investigate cardiac and sympathoadrenal responses to dynamic exercise, heart rate, systolic blood pressure, serial plasma norepinephrine (NE) and epinephrine (E) concentrations during multistage treadmill exercise were measured in 24 hyperthyroid patients (mean age; 42 +/- 16) and 24 age-sex matched control subjects. Eleven patients were re-examined in the euthyroid state after antithyroid therapy. Exercise duration was shorter in patient with hyperthyroidism. Also, the heart rates and systolic blood pressures at rest and in the early stage of exercise were significantly higher in hyperthyroidism. NE at rest (normal vs hyperthyroid: 124 +/- 10 vs 80 +/- 7 pg/ml, p < 0.01) and NE at peak exercise (475 +/- 38 vs 310 +/- 38 pg/ml, p < 0.01) were lower in hyperthyroidism. E at rest (22 +/- 2 vs 29 +/- 4 pg/ml, n.s.) did not differ, however, E during the first stage of exercise (30 +/- 3 vs 69 +/- 12 pg/ml, p < 0.01) was higher in hyperthyroidism. Re-examination for the euthyroid state revealed the decreases in the heart rates and systolic blood pressures at rest and in the early stage of exercise, and the normalization of the NE and E response. Thus, patients with hyperthyroidism was in the hyperdynamic cardiac state at rest and during dynamic exercise, which was accounted for by decreased sympathetic nervous activity and increased adrenomedullary responses. These modifications of sympathoadrenal response seemed reversible when patients were controlled by antithyroid therapy.

摘要

为研究动态运动时的心脏及交感肾上腺反应,对24例甲状腺功能亢进患者(平均年龄42±16岁)及24例年龄和性别匹配的对照者进行了多级跑步机运动期间心率、收缩压、系列血浆去甲肾上腺素(NE)和肾上腺素(E)浓度的测量。11例患者在接受抗甲状腺治疗后处于甲状腺功能正常状态时再次接受检查。甲状腺功能亢进患者的运动持续时间较短。此外,甲状腺功能亢进患者静息时及运动早期的心率和收缩压显著更高。甲状腺功能亢进患者静息时的NE(正常组 vs 甲状腺功能亢进组:124±10 vs 80±7 pg/ml,p<0.01)及运动峰值时的NE(475±38 vs 310±38 pg/ml,p<0.01)较低。静息时的E(22±2 vs 29±4 pg/ml,无显著差异)无差异,然而,甲状腺功能亢进患者运动第一阶段的E(30±3 vs 69±12 pg/ml,p<0.01)更高。甲状腺功能正常状态的复查显示静息时及运动早期的心率和收缩压降低,以及NE和E反应正常化。因此,甲状腺功能亢进患者在静息及动态运动时处于高动力心脏状态,这是由交感神经活动降低和肾上腺髓质反应增加所致。当患者接受抗甲状腺治疗控制时,这些交感肾上腺反应的改变似乎是可逆的。

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