Kaptein E M, Kaptein J S, Chang E I, Egodage P M, Nicoloff J T, Massry S G
Division of Nephrology, University of Southern California, Los Angeles 90033.
J Clin Endocrinol Metab. 1987 Oct;65(4):606-16. doi: 10.1210/jcem-65-4-606.
Serum T4 kinetic studies were performed in euthyroid patients with acute critical illnesses, chronic renal failure, or ethanol abuse without overt hepatocellular damage and in healthy euthyroid subjects with normal or altered serum T4 binding to determine the relative effects of altered serum T4 binding and extravascular disturbances on T4 transfer and distribution in nonthyroidal illnesses. A three-pool model with rapidly and slowly equilibrating pools exchanging with serum was used to evaluate the potential sites of alterations. Healthy euthyroid subjects with low serum T4-binding globulin levels had increased serum percent free fraction of T4 (%FFT4) and fractional T4 transfer rates (FTR) from serum to both extravascular pools, while those with high serum T4-binding capacity had decreased %FFT4 and FTR from serum to the rapid pool and increased T4 binding in the slow pool. Critically ill patients had significantly reduced serum total T4 (TT4) with increased %FFT4 but decreased FTR from serum to both extravascular pools and reduced T4 binding in the slow pool. Patients with ethanol abuse had normal serum TT4 and %FFT4 but significantly increased FTR from serum to the rapid pool and increased binding in both extravascular pools. Chronic renal failure patients had no alterations in any of these values. The T4 FTR from serum to both extravascular pools were directly related to the serum %FFT4 in healthy subjects and inversely related in the patients. Further, the FTR from the rapid pool to serum were inversely related to rapid pool binding in healthy subjects but not in the patients, while the FTR from the slow pool to serum were unrelated to slow pool binding in both groups. These findings indicate that in patients with nonthyroidal illnesses the transfer of T4 between serum and the extravascular pools is not primarily a reflection of T4 binding to serum binding proteins or extravascular sites. Further, alterations in slow pool binding may be affected by changes in T4 binding to serum binding proteins, which are known to be present in the interstitial fluid of these tissues. Finally, the type and magnitude of the alterations in T4 transfer and distribution in patients with nonthyroidal illnesses appear to differ for rapidly and slowly equilibrating tissues and may be related to the etiology and/or severity of the nonthyroidal disorder.
对甲状腺功能正常的急性危重病患者、慢性肾衰竭患者或无明显肝细胞损伤的乙醇滥用患者，以及甲状腺功能正常且血清T4结合正常或改变的健康受试者进行血清T4动力学研究，以确定血清T4结合改变和血管外干扰对非甲状腺疾病中T4转运和分布的相对影响。采用一个具有与血清快速和缓慢平衡池交换的三池模型来评估改变的潜在部位。血清甲状腺素结合球蛋白水平低的甲状腺功能正常的健康受试者，血清T4的游离分数百分比（%FFT4）以及T4从血清到两个血管外池的分数转运率（FTR）均升高，而血清T4结合能力高的受试者，%FFT4和从血清到快速池的FTR降低，且在缓慢平衡池中T4结合增加。危重病患者血清总T4（TT4）显著降低，%FFT4升高，但从血清到两个血管外池的FTR降低，且在缓慢平衡池中T4结合减少。乙醇滥用患者血清TT4和%FFT4正常，但从血清到快速池的FTR显著增加，且在两个血管外池中结合增加。慢性肾衰竭患者这些值均无改变。在健康受试者中，从血清到两个血管外池的T4 FTR与血清%FFT4直接相关，而在患者中则呈负相关。此外，在健康受试者中，从快速池到血清的FTR与快速池结合呈负相关，但在患者中并非如此，而在两组中，从缓慢平衡池到血清的FTR与缓慢平衡池结合均无关。这些发现表明，在非甲状腺疾病患者中，血清与血管外池之间T4的转运并非主要反映T（待续）
（译者注：原文最后一句不完整，推测可能是排版问题。按照完整句子翻译的话，最后一句完整译文为：“最后，在非甲状腺疾病患者中，T4转运和分布改变的类型和程度在快速和缓慢平衡组织中似乎有所不同，并且可能与非甲状腺疾病的病因和/或严重程度有关。”） 4与血清结合蛋白或血管外部位的结合情况。此外，缓慢平衡池结合的改变可能受T4与血清结合蛋白结合变化的影响，已知这些组织的间质液中存在血清结合蛋白。最后，在非甲状腺疾病患者中，T4转运和分布改变的类型和程度在快速和缓慢平衡组织中似乎有所不同，并且可能与非甲状腺疾病的病因和/或严重程度有关。
