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甲状腺疾病时的呼吸功能

Author
Douglas C Johnson, MD
Section Editor
Douglas S Ross, MD
Deputy Editor
Jean E Mulder, MD
Translators
武晓泓, 主任医师

引言

许多甲状腺疾病可导致肺部问题，这些疾病包括甲状腺功能减退、甲状腺功能亢进、结节性甲状腺肿和甲状腺癌。甲状腺功能减退和甲状腺功能亢进均可引起呼吸肌无力及降低肺功能。甲状腺功能减退可降低呼吸驱动，并可引起阻塞性睡眠呼吸暂停或胸腔积液，而甲状腺功能亢进则可增加呼吸驱动，引起劳力性呼吸困难。结节性甲状腺肿和甲状腺癌可压迫气管(可能是位置性的)，另外，甲状腺癌可转移至肺部。

甲状腺功能减退

通气驱动抑制 — 一些甲状腺功能减退患者存在肺泡通气不足[1]。在黏液性水肿性昏迷的极端情况下，可以有明显的高碳酸血症[2]。严重的甲状腺功能减退可引起缺氧通气驱动和高碳酸通气驱动明显抑制，而不太严重的甲状腺功能减退(甲状腺素替代治疗停止3周)可引起缺氧通气驱动中度降低(图 1和图 2) [3,4]。一项小型研究显示，甲状腺素治疗可明显改善缺氧通气驱动的抑制，但不能显著改善高碳酸通气驱动的抑制[3]。另一项研究中，对于有预处理迟钝反应的甲状腺功能减退患者组，胃肠外甲状腺激素替代治疗一周可改善缺氧和高碳酸通气反应[4]。

呼吸肌无力 — 甲状腺功能减退时可发生骨骼肌病[5]；动物研究显示，在甲状腺全切除术后4周，膈肌和肋间肌的1型纤维比例下降[6]。甲状腺功能减退患者的呼吸肌肌力有所降低，治疗后可改善；该肌力降低是由肌病和神经病变引起的。一项纳入6例患者的研究显示，通过治疗，患者的最大呼气和吸气压力降低并改善[7]。一项纳入43例甲状腺功能减退患者的研究显示，呼吸肌肌无力的程度与甲状腺功能减退的程度有关[8]。肌无力的程度通常是轻至中度，但也有存在显著肌无力患者的病例报告[9]。通过治疗，呼吸肌肌力可得到改善[8,9]。

肺功能 — 一氧化碳弥散量(DLCO)可能较低，而在治疗期间可能增加；一项研究显示，治疗前和治疗期间的DLCO平均值分别为预测值的63%和93%[1]。低DLCO及其改善的原因目前尚不清楚。

非肥胖的甲状腺功能减退患者具有正常的肺容积，而肥胖的甲状腺功能减退患者的肺活量和肺容积则有中度减少。关于甲状腺功能减退和肺功能及呼吸肌肌力的研究并未报道DLCO值，但甲状腺素治疗可改善肺活量[8,9]。

            

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Literature review current through: 2017-07 . | This topic last updated: 2016-05-02.
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