甲狀腺功能低下症患者中樞神經傳導之研究：甲狀腺素治療之效果

本研究是利用體感覺誘發電位(SSEP)、腦幹聽覺誘發電位(BAEP)、及視覺誘發電位(VEP)等神經電氣生理學檢查，來探討甲狀腺功能低下時中樞神經受影響之程度及甲狀腺功能恢復正常後中樞神經經傳導功能之變化，以做為診斷及治療之參考。研究中收集20位原發性甲狀腺功能低下症患者，平均年齡為38.3±11.2歲，平均罹病時間為2.1±2.4年，平均治療時間為4.8±3.1月。治療前，15位患者伴有智能障礙。體感覺誘發電位中N9、N13、及N20之平均潛時與正常組比對呈現有意義之差別，但中樞傳導時間(CCT)沒有顯示出統計學意義之延長；腦幹聽覺誘發電位中wave I、II、V、I-III、I-V、及III-V之平均潛時均呈現有意義之延長；視覺誘發電位之P100平均潛時亦呈現有意義之延長，而平均振幅則呈現有意義之降低。甲狀腺素治療後，大部份患者的智能障礙都獲得改善；體感覺誘發電位中N9、N13、N20、及中樞傳導時間之平均潛時，腦幹聽覺誘發電位中wave I、III、V、I-III、I-V、及III-V之平均潛時，視覺誘發電位之P100平均潛時與振幅等均較治療前呈現有意義之進步。我們認為甲狀腺功能低下會引起中樞神經傳導功能異常，且通常是可逆性。臨床上，治療甲狀腺功能低下症時，應用體感覺誘發電位、腦幹聽覺誘發電位、或視覺誘發電位等神經電氣生理學檢查來客觀評估中樞神經傳導功能的變化，有其必要性。

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並列摘要

Employing a Nicolet Ca100 machine, 20 patients of primary hypothyroidism were selected for electrophysiological studies, including somato-sensory evoked potential (SSEP), brainstem auditory evoked potential (BAEP), and visual evoked potential (VEP), to assess the central nerve conduction before and after administration of the thyroid hormone. Before thyroxine replacement therapy, the latenciese of N9, N13, and N20 in SSEP showed significant delay, while the central conduction time (CCT) merely had a tendency of prolongation. In BAEP, the peak and interpeak latencies delayed significantly. Additionally, the latency and amplitude of VEP also had significant difference between patients and controls. After thyroxine replacement, the SSEP, BAEP, and VEP studies revealed significant improvement, in correlation with clinical amelioration. In conclusion, the central nerve conduction would be affected in primary hypothyroidism and the improvement was usually the case, reflecting the clinical recovery after appropriate treatment. The electrophysiological study provides an objective method for monitoring the function of central nervous system in hypothyroidism before and thyroxine treatment.

並列關鍵字

hypothyroidism ； evoked potentials(EPs)

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甲狀腺功能低下症患者中樞神經傳導之研究：甲狀腺素治療之效果

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