Endocrinological disturbances in chronic obstructive pulmonary disease
Endocrinological disturbances in chronic obstructive pulmonary disease
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DOI：
10.1183/09031936.03.00004610
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发表时间：
2003-11-01
影响因子：
24.3
通讯作者：
Casaburi, R
中科院分区：
文献类型：
--
作者：
Creutzberg, EC;Casaburi, R
本文综述了慢性阻塞性肺疾病（COPD）中内分泌紊乱的现有文献，重点介绍了生长激素/胰岛素样生长因子I （IGF-I）、甲状腺激素和合成代谢类固醇。在慢性阻塞性肺病中，人们对循环生长激素或IGF-I浓度知之甚少。一些作者发现生长激素或igf - 1减少，另一些则增加。生长激素的增加可能反映了身体对压力的非特异性反应（例如，低氧血症）。到目前为止，只有一项关于生长激素补充的对照研究发表，但没有显示任何功能益处。在建议将生长激素补充作为COPD治疗的一部分之前，必须进行进一步的对照研究以调查其功能功效。慢性阻塞性肺病中甲状腺功能障碍的患病率及其在肺恶病质中的作用尚未得到广泛研究。到目前为止，没有证据表明甲状腺功能在慢性阻塞性肺病患者中持续改变，除了可能在严重低氧血症患者亚组中。需要进一步的研究来更广泛地研究慢性阻塞性肺病亚组患者甲状腺功能紊乱的潜在机制和后果。一些研究报道了合成代谢类固醇补充治疗慢性阻塞性肺疾病的结果。尽管一些研究发现，低循环睾酮水平在慢性阻塞性肺疾病男性患者中很常见，但对这些患者性腺功能减退的患病率、潜在原因或功能后果知之甚少。全身糖皮质激素的使用和全身炎症反应的影响被认为是导致睾酮水平低的原因。可以假设，低合成代谢激素会减少肌肉质量，最终导致肌肉功能下降。在建议男性慢性阻塞性肺疾病患者使用睾酮替代疗法之前，还需要进一步的证据。
In this overview, the available literature on endocrinological disturbances in chronic obstructive pulmonary disease (COPD) is reviewed, with stress on growth hormone/insulin-like growth factor I (IGF-I), thyroid hormone and the anabolic steroids.In COPD, little is known about circulating growth hormone or IGF-I concentrations. Some authors find a decrease in growth hormone or IGF-I, others an increase. An increase of growth hormone might reflect a nonspecific response of the body to stress (for instance, hypoxaemia). Until now, only one controlled study on growth hormone supplementation has been published, which however did not reveal any functional benefits. Before growth hormone supplementation can be advised as part of the treatment in COPD, further controlled studies must be performed to investigate its functional efficacy. The prevalence of thyroid dysfunction in COPD and its role in pulmonary cachexia has not been extensively studied. So far, there is no evidence that thyroid function is consistently altered in COPD, except perhaps in a subgroup of patients with severe hypoxaemia. Further research is required to more extensively study the underlying mechanisms and consequences of disturbed thyroid function in this subgroup of COPD patients.A few studies have reported the results of anabolic steroid supplementation in chronic obstructive pulmonary disease. Although some studies have discerned that low circulating levels of testosterone are common in males with chronic obstructive pulmonary disease, little is known about the prevalence, the underlying causes or functional consequences of hypogonadism in these patients. The use of systemic glucocorticosteroids and an influence of the systemic inflammatory response have been suggested as contributing to low testosterone levels. It can be hypothesised that low anabolic hormones will reduce muscle mass and eventually result in a diminished muscle function. Further evidence is required before testosterone replacement can be recommended for males with chronic obstructive pulmonary disease.