Kamoi Kyuzi, Tanaka Midori, Ikarashi Tomoo, Miyakoshi Masashi
The Diabetes and Endocrine & Metabolism Disease Center, Nagaoka Red Cross Hospital, Nagaoka, Niigata, Japan.
Endocr J. 2006 Aug;53(4):511-21. doi: 10.1507/endocrj.k06-022. Epub 2006 Jul 10.
A major earthquake (Richter scale magnitude 6.8) struck the Chuetsu district of Niigata Prefecture, Japan, a rural area with mountain villages, on October 23, 2004. Strong aftershocks (Grade 5-6 on the Japanese intensity scale, JIS) continued for 2 months. We analyzed the earthquake's impact on 229 patients with various endocrine disorders [6 central diabetes insipidus (CDI), 16 adrenal insufficiency (AI) including 5 panhypopituitarism, 10 ACTH isolated deficiency and 1 Addison's disease, 145 Graves' disease and 62 Hashimoto's disease]. The status of patients with CDI or AI was not adversely affected by the earthquake. Twenty-eight (19%) patients with Graves' disease developed more severe hyperthyroidism; the incidence of developing more severe hyperthyroidism increased with greater degrees of hyperthyroidism. Three (5%) patients with Hashimoto's disease developed increased TSH concentrations. Most patients stayed in their own houses following the first shock. The median PTSD total score for all patients was low. However, the PTSD total score in patients with CDI or Hashimoto's disease was significantly higher than in other patients, while the subscore of mental status in patients with AI was significantly much lower than in other patients. In patients with Hashimoto's disease, patients whose hypothyroidism worsened had higher total and environmental effects score than patients whose hypothyroidism remained stable. Comparing patients whose hyperthyroidism became more severe to those in whom it remained stable, as well as on multiple logistic regression analysis, serum TRAb was found to be a risk factor for developing more severe hyperthyroidism. In conclusion, our findings indicate that Graves' disease patients need to maintain their euthyroid state with a low serum TRAb titer to prevent the development of further thyroid dysfunction after an earthquake, and that all patients should continue to take their medication, since it is likely that their lives will be interrupted by environmental effects owing to earthquake-shock, especially patients with CDI or Hashimoto's disease. Due to the risk of medical facility closure during a disaster, all patients should always have a note or copy of their medical records, including medical history and medications used, to avoid relying on patients remembering their drug names and doses. Furthermore, appropriate information should be provided by all means possible, including the mass media, to affected individuals, particularly those with AI, to decrease the occurrence of adverse consequences.
2004年10月23日，日本新潟县中越地区发生了一场里氏6.8级的大地震，该地区为多山村的乡村地区。强烈余震（日本烈度等级JIS 5 - 6级）持续了两个月。我们分析了此次地震对229例患有各种内分泌疾病的患者的影响[6例中枢性尿崩症（CDI）、16例肾上腺功能不全（AI），其中包括5例全垂体功能减退症、10例促肾上腺皮质激素（ACTH）孤立缺乏症和1例艾迪生病、145例格雷夫斯病和62例桥本甲状腺炎]。CDI或AI患者的病情未受到地震的不利影响。28例（19%）格雷夫斯病患者出现了更严重的甲状腺功能亢进；甲状腺功能亢进程度越高，发生更严重甲状腺功能亢进的发生率越高。3例（5%）桥本甲状腺炎患者促甲状腺激素（TSH）浓度升高。首次地震后，大多数患者留在自己家中。所有患者创伤后应激障碍（PTSD）总分中位数较低。然而，CDI或桥本甲状腺炎患者的PTSD总分显著高于其他患者，而AI患者的精神状态子分数显著低于其他患者。在桥本甲状腺炎患者中，甲状腺功能减退症加重的患者的总分和环境影响分数高于甲状腺功能减退症保持稳定的患者。将甲状腺功能亢进症加重的患者与病情保持稳定的患者进行比较，以及通过多因素逻辑回归分析发现，血清促甲状腺激素受体抗体（TRAb）是发生更严重甲状腺功能亢进症的一个危险因素。总之，我们的研究结果表明，格雷夫斯病患者需要将血清TRAb滴度维持在低水平的甲状腺功能正常状态，以防止地震后进一步出现甲状腺功能障碍，并且所有患者都应继续服药，因为他们的生活很可能会因地震冲击导致的环境影响而中断，尤其是CDI或桥本甲状腺炎患者。由于灾难期间医疗设施可能关闭，所有患者都应始终备有病历记录或副本，包括病史和所用药物，以避免依赖患者记住药物名称和剂量。此外，应通过包括大众媒体在内的一切可能手段，向受影响的个人，特别是AI患者，提供适当信息，以减少不良后果的发生。
