Impact of hypoxaemia on neuroendocrine function and catecholamine secretion in chronic obstructive pulmonary disease (COPD).: Effects of long-term oxygen treatment
Impact of hypoxaemia on neuroendocrine function and catecholamine secretion in chronic obstructive pulmonary disease (COPD).: Effects of long-term oxygen treatment
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DOI：
10.1053/rmed.2000.0953
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发表时间：
2000-12-01
影响因子：
4.3
通讯作者：
Carlström, K
中科院分区：
文献类型：
--
作者：
Bratel, T;Wennlund, A;Carlström, K
该研究的目的是探讨慢性低氧血症对低氧血症慢性阻塞性肺疾病（COPD）神经内分泌功能的影响。通过测量日间血浆儿茶酚胺和夜间尿儿茶酚胺水平来评估压力水平，并通过测量血清促性腺激素、外周性激素和外周甲状腺激素以及在甲状腺释放激素激发前后测量促甲状腺激素（TSH）、催乳素和生长激素来评估内分泌功能。12名男性、稳定、低氧血症患者在至少4个月的长期氧疗（LTOT）前后。治疗前平均 PAO(2) 为 7.39 +/- 0.78 kPa，平均夜间动脉血氧饱和度 (MSaO(2)) 为 86.6 +/- 3.2%。血浆去甲肾上腺素（NE）水平高于正常水平，而所有其他治疗前激素水平均在正常范围内。 1 秒用力呼气量 (FEV1) 较低与基础 TSH 和刺激 TSH 较低相关 (P < 0.01)。尿 NE 排泄量与 SaO(2) < 85% 的夜间时间呈正相关 (P < 0.05)。与正常对照相似，LTOT 前后性激素结合球蛋白和睾酮之间均呈正相关（P < 0.01）。整个研究组平均 8 个月的 LTOT 后没有发现明显的激素变化。然而，在 LTOT 后 MSaO(2) 增加超过 7% 的亚组 (n = 6) 中，NE 和肾上腺素的夜间排泄减少了 30% (P < 0.05)，无 S 甲状腺素减少了 20% (P < 0.05)。 总之，继发于 COPD 的慢性低氧血症患者表现出血浆 NE 水平升高，但内分泌水平正常，包括正常的内分泌水平。下丘脑-垂体-睾丸轴。气道阻塞的严重程度与基础 TSH 和刺激 TSH 的降低有关。 LTOT 后内分泌功能没有显着变化，但有严重夜间低氧血症的亚组除外，其中注意到夜间 NE 排泄增加，只有在氧疗期间整夜氧合正常化时，排泄量才会减少。
The aim of the study was to investigate the effects of chronic hypoxaemia on neuroendocrine function in hypoxaemic chronic obstructive pulmonary disease (COPD). The stress level was assessed by measurement of daytime plasma catecholamine and nocturnal urinary catecholamine levels and endocrine function was assessed by measuring serum gonadotropins, peripheral sex hormones and peripheral thyroid hormones, and by measuring thyroid stimulating hormone (TSH), prolactin and growth hormone before and after thyroid releasing hormone challenge in 12 male, stable, hypoxaemic COPD patients before and after at least 4 months of long-term oxygen treatment (LTOT). Mean pre-treatment PAO(2) was 7.39 +/- 0.78 kPa and mean nocturnal arterial oxygen saturation (MSaO(2)) was 86.6 +/- 3.2%. Plasma norepinephrine (NE) levels were higher than normal, while all other pretreatment hormone levels were within normal range. Low forced expiratory volume in 1 see (FEV1) was associated with low basal and stimulated TSH (P < 0.01). Urinary NE excretion correlated positively to nocturnal time spent with SaO(2) < 85% (P < 0.05). In similarity with normal controls, positive correlations were found between sex hormone binding globulin and testosterone both before and after LTOT (P < 0.01). No significant hormonal changes were noted following an average of 8 months of LTOT for the entire study group. However, in a subgroup (n = 6) with an increase in MSaO(2) exceeding 7% points following LTOT, nocturnal excretion of NE and epinephrine were reduced by 30% (P < 0.05) and S-free thyroxin by 20% (P < 0.05).In conclusion, patients with chronic hypoxaemia secondary to COPD exhibit elevated plasma NE levels but otherwise normal endocrine levels, including a normal hypothalamic-pituitary-testicular axis. The severity of airway obstruction is associated with reduced basal and stimulated TSH. The endocrine function is not significantly changed following LTOT except for a subgroup with severe nocturnal hypoxaemia, where elevated nocturnal NE excretion was noted, which was reduced only if whole night oxygenation was normalized during oxygen therapy.