Sun Z J, Huang X H, Wang M X
First Affiliated Hospital of Nanjing Medical College.
Zhonghua Nei Ke Za Zhi. 1993 Nov;32(11):729-32.
We examined the function of hypothalamic-pituitary target gland axes in 88 cases with epidemic hemorrhagic fever (EHF). It was found that all the three endocrine axes i.e. hypothalamic-pituitary-adrenocortical axis, hypothalamic-pituitary-thyroid axis and hypothalamic- pituitary-gonadal axis showed some functional impairment. In acute phase there were increased plasma ACTH, FSH and LH levels, which might be attributed to stress reaction in EHF patients. Most cases showed low or weak response of TSH to TRH and delayed response of LH to LHRH; some of the cases did not respond to 1mg of glucagon. These manifestations might be related with poor reserve of anterior pituitary or to disordered regulation of endocrine axes. The increased plasma cortisol and estradiol and the decreased plasma T3, T4 as well as testosterone during acute phase may have important clinical significance. Hence we suggest that in any case glucocorticosteroids should not be abused and that in severe patients thyroxine and durabolin should be administered to improve immunity and hepato-renal function.
我们对88例流行性出血热（EHF）患者的下丘脑 - 垂体 - 靶腺轴功能进行了研究。发现所有三个内分泌轴，即下丘脑 - 垂体 - 肾上腺皮质轴、下丘脑 - 垂体 - 甲状腺轴和下丘脑 - 垂体 - 性腺轴均出现了一定程度的功能损害。急性期血浆促肾上腺皮质激素（ACTH）、促卵泡激素（FSH）和促黄体生成素（LH）水平升高，这可能归因于EHF患者的应激反应。大多数病例促甲状腺激素（TSH）对促甲状腺激素释放激素（TRH）的反应低下或微弱，LH对促黄体生成素释放激素（LHRH）的反应延迟；部分病例对1mg胰高血糖素无反应。这些表现可能与垂体前叶储备功能不良或内分泌轴调节紊乱有关。急性期血浆皮质醇和雌二醇升高，血浆三碘甲状腺原氨酸（T3）、甲状腺素（T4）以及睾酮降低，可能具有重要的临床意义。因此我们建议，无论如何都不应滥用糖皮质激素，对于重症患者应给予甲状腺素和苯丙酸诺龙以提高免疫力及肝肾功能。
