扎鲁司特治疗哮喘的临床疗效和安全性观察

目的　探讨扎鲁司特对哮喘患者的疗效和安全性。方法　对３９０ 例哮喘患者进行开放性、非对照、多中心研究， 观察病人用药前及用药后肺功能、哮喘自觉症状、不良反应。结果　扎鲁司特使病人的ＦＥＶ１ 由治疗前的２－１１Ｌ 上升至治疗后２－２８Ｌ， 晨间ＰＥＦ（ＰＥＦａｍ） 从３１５－２２Ｌ／ｍｉｎ 升至３５０－２７Ｌ／ｍｉｎ， 上述肺功能及用药后哮喘症状评分、夜间憋醒次数、无症状天数、吸入性β２ 受体激动剂用量与用药前相比， 均明显改善， Ｐ＜ ０－０１。可疑药物不良反应发生率２－１％ ， 主要是消化道不适和头痛。结论　扎鲁司特可提高哮喘患者的肺功能， 改善哮喘症状， 具有良好的安全性。     

舒利迭联合白三烯拮抗剂扎鲁司特治疗成年哮喘的临床研究

目的探讨舒利迭联合白三烯拮抗剂扎鲁司特治疗成年哮喘的临床研究。方法将我院住院治疗的128例成年哮喘患者分入对照组与观察组,两组均给予哮喘常规治疗,对照组接受舒利迭吸入治疗。给予观察组患者舒利迭联合白三烯拮抗剂扎鲁司特治疗,疗程均为12周。比较两组临床症状评分、肺功能及生活质量的差别。结果治疗后2周及4周,观察组临床症状评分显著优于对照组(P<0.05);治疗后8周及12周观察组患者FEV1改善率显著优于对照组(P<0.05);治疗后12周观察组支气管哮喘生存质量评估(AQLQ)评分显著优于对照组,差别具有统计学意义(P<0.05)。结论舒利迭联合白三烯拮抗剂扎鲁司特治疗成年哮喘,改善患者临床症状、肺功能及生活质量效果更为理想。     

丙酸氟替卡松治疗哮喘患者的疗效评价

目的 评价短期使用新型吸入型糖皮质激素—丙酸氟替卡松的有效性和安全性。方法 50例未达到控制的支气管哮喘患接受6周的吸入丙酸氟替卡松治疗，于用药前后比较日、夜间症状评分，短效β2—受体激动剂按需使用次数，晨间、夜间PEF值及试验开始和结束时的FEVl值。结果 治疗后各项指标均有明显改善。在症状改善方面优于肺功能改善。肺功能指标的改善在中、重度哮喘患明显。上述剂量短期内使用安全可靠。结论 中等剂量的丙酸氟替卡松临床疗效显、安全性好是目前治疗哮喘的最佳的吸入激素制剂之一。     

扎鲁司特治疗哮喘的疗效和气道炎症相关性研究

目的本研究观察扎鲁司特是否影响轻、中度支气管哮喘患者气道中嗜酸性粒细胞的数量。方法23例成人哮喘患者予白三烯受体拮抗剂扎鲁司特(商品名安可来)20mg,1d2次,连续治疗13wk。试验中记录患者的哮喘症状评分、夜间憋醒次数、β受体兴备剂使用量、肺功能第一秒用力呼气量占总肺活量百分比(FEV2FVC)及呼气峰流速(PEF)。试验前后分别行纤维支气管镜支气管肺泡灌洗,记录气道炎症细胞数量及比例,对治疗前后BALF嗜酸粒细胞计数差值和FEV1治疗前后差值进行相关分析。结果治疗前后患者的夜间憋醒次数、β2受体激动剂使用次数均显著减少,PEF明显改善,治疗前后BALF嗜酸粒细胞计数差值和FEV1治疗前后差值相关。结论白三烯受体拮抗剂对轻、中度哮喘患者具有减轻症状、改善肺功能、抗炎作用,能减少轻、中度支气管哮喘患者气道中嗜酸性粒细胞的数量。     

舒利迭联合扎鲁司特治疗儿童支气管哮喘的疗效及对肺功能的影响

目的观察舒利迭联合扎鲁司特治疗儿童支气管哮喘的疗效,并评价用药方案对患儿肺功能的影响。方法将115例支气管哮喘患儿随机分为两组,均给予常规治疗,对照组(n=57)加舒利迭,观察组(n=58)给予舒利迭联合扎鲁司特治疗;比较两组患者治疗1月后的疗效和肺功能变化情况。结果观察组的临床总有效率明显高于对照组(P0.05);观察组治疗后的FEV_1、PEF均高于对照组(P0.05);两组患儿未见严重不良反应。结论舒利迭联合扎鲁司特治疗儿童支气管哮喘的疗效肯定,能够有效改善患儿肺功能,安全性好。     

速尿雾化吸入对哮喘发作期患者肺功能的影响

目的：观察速尿雾化吸入对哮喘发作期患肺功能的影响。方法：将哮喘发作期患64例，随机分为治疗组和对照组，治疗组以速尿60mg 生理盐水4ml雾化吸入，对照组以生理盐水10ml雾化吸入；两组均于吸药前及吸药后30min记录症状、肺部罗音及测量肺功能（FVC、FEV1、PEF、V50、V25），其占预计值百分比依次为（FVC％，FEV1％、PEF％、V56％及V25％），同时治疗组分别没量心率、血压及呼吸频率，并观察各项指标的变化。结果：治疗组经速尿雾化吸入后临床症状及肺功能有明显改善，差异有非常显性（P＜0．01），吸药前、后心率、血压及呼吸频率比较差异不明显（P＞0．05）。结论：吸入速尿对急发期哮喘患有非常明显的平喘作用，并能改善肺功能，而又不增加心率及升高血压。     

白三烯拮抗剂联合吸入糖皮质激素治疗慢性中度持续支气管哮喘的临床疗效观察

目的评价白三烯拮抗剂联合吸入糖皮质激素对慢性中度持续支气管哮喘患者肺功能及疗效的影响。方法选取我院2010年2月~2013年1月收治的60例慢性中度持续支气管哮喘患者,按照随机数字表法随机分为治疗组与对照组各30例,对照组给予氟替卡松气雾剂吸入200μg,1次/d;治疗组在对照组基础上加用孟鲁司特钠咀嚼片,10 mg口服,1次/d。两组患者疗程均为4周。结果治疗4周后两组患者各项肺功能指标均较治疗前明显改善(P0.05),但同期比较治疗组较对照组改善更为明显(P0.05),治疗组总有效率显著高于对照组(χ2=15.427,P0.01)。结论白三烯拮抗剂联合吸入糖皮质激素可显著缓解临床症状及体征、改善肺功能指标,且安全性较高。     

半胱氨酰白三烯受体拮抗剂对成人哮喘的临床疗效观察

目的 系统观察半胱氨酰白三烯（CysLTs）受体拮抗剂安可来在不同严重程度哮喘患者中的疗效及其安全性。方法 117例成人哮喘患者,其中轻度哮喘62例,中度哮喘34例,重度哮喘21例。口服安可来20mg,2次／d,持续服用4周。结果 轻、中、重度哮喘患者口服安可来后日间及夜间症状计分、液间憋醒次数、吸入β2－受体激动剂用量及肺功能指标包括FEV1（轻度患者除外）、PEFRam、PEFRpm均有显著改善,与安可来相关的可颖药物发生不良反应5例（4％）,症状轻微,无需特别处理。结论 安可来对各种严重程度哮喘均具有缓解哮喘症状及改善肺功能的作用,且具有服用方便、副作用少、耐受性好的优点。     

信必可都保治疗轻中度哮喘临床疗效观察

目的评价信必可都保在治疗轻、中度支气管哮喘的临床疗效及安全性。方法对我院30例临床诊断哮喘的轻中度患者应用信必可都保吸入治疗,治疗后4、12周测定第1秒用力呼气容量（FEV1）、FEV1占预计值的百分比（FEV1%）、呼气50%用力肺活量时的流速（FEF50%）和峰值流速（PEF）,观察临床疗效,进行治疗前后对比研究。结果30例中临床控制25例（83.3%）,显效3例（10%）,好转2例（6.7%）。治疗后4周、12周患者哮喘症状较治疗前明显改善（P〈0.05）。治疗后4周、12周患者肺功能监测指标FEV1、FEV1%、FEF50%、PEF较治疗前明显增加（P〈0.05）;但治疗后4周与治疗后12周之间无统计学差异。结论信必可都保吸入治疗轻中度哮喘起效迅速、疗效确切、安全、副作用小、患者依从性好,值得临床推广应用。     

吸烟对支气管哮喘患者吸入糖皮质激素治疗的影响

目的 探讨吸烟对支气管哮喘(简称哮喘)患者临床症状、肺功能及气道炎症的影响,以及对激素治疗的敏感性.方法 选取2009年12月至2011年1月门诊就诊的40例慢性持续期哮喘患者,根据是否吸烟分为吸烟组(15例)和非吸烟组(23例).所有患者给予糖皮质激素(布地奈德)吸入治疗,必要时可吸入β2受体激动剂.发放哮喘日记卡及峰流速仪.记录治疗前及治疗28 d后哮喘症状评分、哮喘控制测试(ACT)评分、肺功能、晨间及夜间最高呼气流速(PEF),诱导痰中嗜酸粒细胞及中性粒细胞百分比,并测定痰液中白介素8(IL 8)及嗜酸粒细胞趋化因子(eotaxin)水平.结果 两组患者治疗前除性别构成外,年龄、病程、ACT评分、肺功能指标差异均无统计学意义.两组患者治疗后ACT评分(F=39.991,P＜0.05)、FEV1％ pred(F=56.075,P＜0.05)、PEF％ pred(F=53.535,P＜0.05),嗜酸粒细胞百分比(F=15.271,P＜0.05)及eotaxm(F=24.172,P＜0.05)水平均较治疗前有明显改善,哮喘症状评分显著降低(P ＜0.05).其中非吸烟组以上指标的改善程度均优于吸烟组(P＜0.05).结论 吸烟降低了哮喘患者对ICS治疗的反应性.对吸烟的哮喘患者,治疗可能需要特殊调整.     

An evaluation of severity-modulated compliance with q.i.d. dosing of inhaled beclomethasone.

Although the asthmatic subject's compliance with a regimen of inhaled corticosteroids is often poor, it has been suggested this may improve during periods of increased severity. To test this, we measured daily peak expiratory flow rates (PEFRs), asthma symptoms, and the use of an albuterol inhaler over nine weeks period in ten patients with moderately severe asthma. The effect of changes in these severity indices on compliance with a q.i.d. regimen of inhaled beclomethasone was evaluated. The PEFR was measured in the morning before bronchodilator administration, and symptoms were graded on a scale of 4 to 16, while albuterol and beclomethasone inhalations were electronically recorded. Three measures of compliance with the beclomethasone regimen were used: (1) mean daily compliance ([number of inhalations/number of prescribed inhalations] x 100); (2) underuse, ie, the percentage of days with less than the prescribed number of inhalations; and (3) overuse, ie, the percentage of days with greater than the prescribed number of inhalations. Mean daily compliance was 67 +/- 36 percent, while underuse was observed in 69 percent and overuse in 11 percent of the days. Despite clinical exacerbations in six of the ten patients and considerable variation in the severity indices, no significant relationship was found between the change in asthma severity and compliance with the beclomethasone regimen. These findings do not support the concept of severity-modulated compliance with inhaled corticosteroids.     

Breathing during sleep in stable asthmatic subjects. Influence of inhaled bronchodilators

The bronchoconstriction of asthma displays a circadian rhythm with exacerbations often occurring in the early morning hours. Gas exchange abnormalities during sleep in patients with severe asthma have been documented; however, the influence of sleep on gas exchange in the asthmatic with few or no daytime or nocturnal symptoms is poorly understood. To determine if abnormalities in oxygenation might occur during sleep, we studied 12 stable adult asthmatic patients with reversible airflow obstruction during sleep on three consecutive nights, with night 1 being for acclimatization. On test nights 2 and 3, the subjects received, in random double-blind fashion, either inhaled fenoterol or its placebo. Spirometry was performed before and after bronchodilator treatment and on the next morning. The mean FEV1 was 63 percent predicted before treatment. There was significant (p less than 0.05) improvement in FEV1 on fenoterol night after treatment which was also present the next morning. Mean prefenoterol FEV1 was 2.04 +/- .15 (SEM) and increased to 2.61 +/- .17 after the bronchodilator. The mean morning FEV1 was 2.27 +/- .20. Mean preplacebo FEV1 was 2.07 +/- .12 and did not change significantly with placebo bronchodilator. Sleep analysis demonstrated no significant differences in total sleep time or duration of oxyhemoglobin desaturation between nights. The incidence of sleep disordered breathing was very low (0.14 apneas/hour). The frequency of apneas and hypopneas did not change significantly with treatment. Two of the 12 subjects experienced an asthma attack on placebo night which did not recur following active bronchodilator administration. We conclude that stable asthmatic patients with few nocturnal complaints have a low frequency of disordered breathing and desaturation events during sleep.     

吸入沙美特罗／氟替卡松治疗儿童支气管哮喘临床疗效与骨密度观察

目的观察支气管哮喘（简称哮喘）儿童吸入沙美特罗／氟替卡松（商品名舒利迭）治疗儿童哮喘的临床疗效与骨密度变化。方法随机、自身对照法观察500例[男288例,女212例,平均年龄（9．5±4．8）岁],轻、中、重度各62例、278例和98例]哮喘儿童吸入沙美特罗／氟替卡松（50／100μg）,每次一吸,轻、中度2次／d,重度2次／d＋辅舒酮125μg,按需用短效β2受体激动剂。每2～8周评估1次病情控制情况,240例患儿由专人观察记录患儿自身治疗前后的早、晚PEF％（实测值／预计值）,日、夜间症状评分,β2受体激动剂应用揿数,医师综合疗效评价,急诊、住院次数及骨密度和其他不良反应。结果肺功能、日、夜间症状评分,医师对疗效的评价均随治疗时间的延长有显著好转或改善,而β2受体激动剂用量和急诊、住院次数则显著减少,骨密度原降低者均恢复正常或显著改善,原正常者均正常。偶有声哑等轻微局部不良反应。结论沙美特罗／氟替卡松能显著改善哮喘儿童肺功能,控制哮喘日、夜间症状,减少β2受体激动剂用量和急诊或住院次数,提高患儿生活质量,无明显不良反应,是当前理想的哮喘治疗药物。     

A Randomized Pilot Study of Acupuncture as an Adjunct Therapy in Adult Asthmatic Patients

Objective. This trial aimed to evaluate the feasibility of estimating the effectiveness of acupuncture on asthmatic patients under conventional medical management. Participations and Methods. A prospective randomized, patient/assessor-blinded, sham acupuncture–, and waiting list–controlled pilot trial was conducted. Forty-five eligible asthmatic participants underwent a 1-week run-in period and were then randomized into one of three groups: an active acupuncture group, a sham acupuncture group, and a waiting list group. They were instructed to maintain the use of antiasthmatic medications. Needling was administered three times per week for 4 weeks with a 2-week follow-up in the active and sham acupuncture groups. The primary outcome was daily morning peak expiratory flow (PEF) and the secondary outcomes included forced expiratory volume one second (FEV₁), quality of life questionnaire for adult Korean asthmatics (QLQAKA), transition dyspnea index (TDI), serum eosinophil count, and total serum immunoglobulin E (IgE). Results. No significant differences in the between- or within-group values of weekly average PEF (recorded daily in the morning) and FEV₁ were found. For QLQAKA and TDI, the active acupuncture group showed a significant improvement over the waiting list group at 2, 4, and 6 weeks after randomization. Discussion. Acupuncture as an adjunct therapy to conventional medical care does not seem to affect pulmonary function in asthmatic patients. However, 12 sessions of acupuncture treatment during 4 weeks showed a favorable effect on the quality of life in adult asthmatic patients. Further large trials assessing the effectiveness of acupuncture on the quality of life and symptoms in asthmatic patients are needed.     

Comparison of the bronchodilating effect of salmeterol and zafirlukast in combination with that of their use as single treatments in asthma and chronic obstructive pulmonary disease.

BACKGROUND: It has been suggested that the effect of a beta2-agonist is additive with that of a cysteinyl leukotriene 1 receptor antagonist. OBJECTIVES: The present study was designed to answer the question of whether combined administration of inhaled salmeterol and oral zafirlukast at the standard doses would result in greater bronchodilation in patients with chronic airway obstruction than the use of either drug alone. METHODS: The study was performed using a double-blind, double-dummy, crossover, randomised design, and was conducted on 4 non-consecutive days. Sixteen patients with moderate to severe chronic obstructive pulmonary disease (COPD) and 10 non-smoker asthmatic patients received 40 mg of oral zafirlukast, 50 microg of inhaled salmeterol, 50 microg of inhaled salmeterol plus 40 mg of oral zafirlukast of placebo. Lung function was assessed before drug administration and 30, 60, 120, 180 and 240 min thereafter. At the end of the 4-hour period, each patient received 400 microg of inhaled salbutamol and spirometric testing was performed 30 min later. RESULTS: In both asthmatic and COPD patients, the overall effect of salmeterol and zafirlukast on the forced expiratory volume in 1 s (FEV1) was considered extremely significant (p < 0.0001), with a maximum bronchodilation above baseline after 180 min (20.7 and 11.0%, respectively) in asthmatics and after 2 h (21.7 and 11.2%, respectively) in COPD subjects. Zafirlukast did not produce any further significant acute bronchodilation in addition to that achieved with salmeterol alone in either asthmatic or COPD patients. Nevertheless, 7 out of 16 COPD patients and 7 out of 10 asthmatic patients had a further improvement after the combination of salmeterol and zafirlukast. The mean difference in pre- and post-salbutamol FEV1 values in both asthmatic and COPD patients after zafirlukast was significant (p < 0.05), but that after salmeterol and the combination of the two drugs was not significant (p > 0.05). The difference between placebo and zafirlukast was not significant following inhaled salbutamol given 4 h after each treatment. Conclusions: Both salmeterol and zafirlukast induced a significant increase in FEV1, although salmeterol elicited a greater improvement in both asthmatic and COPD patients. Apparently, zafirlukast at the clinically recommended dose did not produce any further significant acute bronchodilation in addition to that achieved with salmeterol alone, either in asthma or COPD. In any case, evaluation of the effect of the combination over a 12-hour period is mandatory.     

Time-dependent changes in orally exhaled nitric oxide and pulmonary functions induced by inhaled corticosteroids in childhood asthma.

Exhaled nitric oxide levels are elevated in asthmatic children and decrease after inhaled steroid treatment. We evaluated the time-dependent changes in fractional exhaled nitric oxide concentration (FENO) and pulmonary function parameters following inhaled steroid therapy. Thirty-nine steroid-naive atopic patients (age 11.92+/-0.48 years) with mild intermittent asthma and 22 age-matched healthy controls were enrolled in the study; pulmonary functions and FE(NO) levels were measured. Low doses of inhaled steroids were prescribed to all asthmatic patients who were reevaluated in a second visit (between 10 and 40 days after the beginning of the treatment). At the enrolment, asthmatic patients had similar forced expiratory volume in 1 sec (FEV1) and forced vital capacity (FVC) values (p > 0.05) but reduced forced expiratory flows at 25-75% of the vital capacity (FEF(25-75%)) values, as compared to controls (p < 0.05). In addition, FE(NO) levels were significantly higher in asthmatics with respect to control subjects (30.8+/-3.0 and 4.0+/-0.5 ppb, respectively; p < 0.01). All asthmatics had FE(NO) levels higher than 8.8 ppb (i.e., > 2 standard deviations of the mean in controls). After steroid treatment, patients showed significant improvement of FEV1, FVC, and FEF(25-75%) (p = 0.0001; each comparison) and a reduction of FE(NO) levels (p = 0.0001). A weak significant correlation was found between percent decrease in FE(NO) levels and percent increase in FEV1 (r = 0.33, p = 0.04) or in FEF(25-75%) (r = 0.4, p = 0.01) after treatment. When changes in FE(NO) levels and in pulmonary function parameters were corrected for days of treatment, significant correlations were still present between percent decrease in FE(NO) levels and percent increase in FEV1 (r = 0.57, p = 0.0004) or percent increase in FEF(25-75%) (r = 0.45, p = 0.006). Sixteen of the 39 asthmatic patients were evaluated on two occasions after the beginning of treatment, at days 10 and 40. The significant reduction in FE(NO) levels (p < 0.01) and the significant increase in FEV1 and FEF(25-75%) values observed (p < 0.05) after 10 days did not further improve at day 40. These data show that it is possible to demonstrate early effects of low-dose inhaled steroids in asthmatic children using objective measurements of airway caliber and inflammation.     

抗反流药物治疗对支气管哮喘伴胃食管反流患者哮喘症状影响的荟萃分析

目的 荟萃分析抗反流药物治疗对支气管哮喘(简称哮喘)伴胃食管反流患者哮喘症状的影响.方法纳入对合并胃食管反流的哮喘患者行抗反流治疗的前瞻性随机对照试验,抗反流治疗干预要求使用双肓法,样本量大小、匹配方式不限,研究对象为年龄＞13岁的伴胃食管反流病的哮喘患者.检索PubMed数据库、Embase数据库、Cochrane图书馆临床对照试验数据库、OVID数据库、中国生物医学文献数据库、中国知网全文数据库、万方科技期刊全文数据库.手工检索<中华结核和呼吸杂志>、<中华消化杂志>、<中华内科杂志>、CHEST及纳入文献的参考文献.所有检索均截至2009年11月.排除研究对象在进入研究前3 d内服用过抗反流药物、重复或多重发表、方法学质量评价为B级以下的文献.运用Cochrane荟萃分析的方法,由2名评价员独立对试验进行筛选、质量评价、数据提取和交叉核对.使用Revman 4.3.2软件对数据合并进行统计分析,评价抗反流药物治疗对哮喘伴胃食管反流患者哮喘的疗效.结果共纳入14项临床随机对照试验,包括1555例患者.抗反流治疗组与安慰剂组相比,FEV1增加[加权均数差(WMD)为0.11 L;95%可信区间(95%CI)为0.02～0.20;Z=2.49,P=0.010];日间最大呼气流速(PEF)增加(WMD为42.33 L/min;95%CI为3.39～81.28;Z=2.13,P=0.030);早晨PEF增加(WMD为16.16 L/min;95%CI为5.91～26.41;Z=3.09,P=0.002);夜间PEF增加(WMD为18.35 L/min;95%CI为6.77～29.92;Z=3.11,P=0.002).抗反流治疗与安慰剂治疗后比较,FEV1较基础对照值降低达20%时的吸入乙酰胆碱浓度(PC20-FEV1)减低(WMD为-0.07 mg/L;95%CI为-0.33～0.19),但差异无统计学意义(Z=0.55,P=0.590).14项研究中有8项研究在抗反流治疗后观察到哮喘症状改善,但荟萃分析显示哮喘日间症状和夜间症状的改善均无统计学意义.结论抗反流治疗可改善合并胃食管反流病哮喘患者的肺通气功能,但对气道高反应性和哮喘症状无显著影响.     

Chronobiology and Asthma. I. Day-Night Differences in Bronchial Patency and Dyspnea and Orcadian Rhythm Dependencies

The symptoms of allergic asthmatic patients typically worsen during the night, especially during the early morning hours. Although 24-hour variations in the environment contribute to the intensification of the asthmatic condition nocturnally, environmental changes themselves do not fully explain the temporal aspects of this disease. Orcadian (about 24-hour) rhythms in critical bioprocesses constitute significant contributory factors. The exacerbation of asthma during the night represents the changing status of biological functioning due to circadian rhythms in bronchial patency; airways hyperreactivity to acetylcholine, histamine, and house dust; and plasma cortisol, epinephrine, histamine, and cyclic AMP, among others.     

Chronobiology and Asthma. I. Day-Night Differences in Bronchial Patency and Dyspnea and Orcadian Rhythm Dependencies

The symptoms of allergic asthmatic patients typically worsen during the night, especially during the early morning hours. Although 24-hour variations in the environment contribute to the intensification of the asthmatic condition nocturnally, environmental changes themselves do not fully explain the temporal aspects of this disease. Orcadian (about 24-hour) rhythms in critical bioprocesses constitute significant contributory factors. The exacerbation of asthma during the night represents the changing status of biological functioning due to circadian rhythms in bronchial patency; airways hyperreactivity to acetylcholine, histamine, and house dust; and plasma cortisol, epinephrine, histamine, and cyclic AMP, among others.     

Lack of nocturnal serum thyrotropin surge after surgery

The effects of surgery on TSH secretion, with particular regard to the nocturnal TSH surge, were evaluated in 10 consecutive patients followed for 6 days after surgery. Surgical trauma was associated in all patients with significant decreases in serum total and free T3 and a significant increase in serum rT3 levels, with no variations in serum total and free T4 concentrations. A marked increase in serum cortisol levels was observed, with higher values at night than in the morning. Serum cortisol levels and circadian rhythm normalized on the fifth day. Serum TSH values in the morning significantly decreased on the first day after surgery and returned to normal on the second day. Serum TSH values at night (2400-0200 h) were higher than in the morning preoperatively, but the nocturnal surge was abolished from days 1-5 after surgery and was restored only on the sixth day. Thus, surgery was associated with a prolonged loss of the nocturnal serum TSH surge. This effect on TSH secretion was more marked than predictable on the basis of serum TSH measurements in the morning alone. An inverse relationship was found between serum cortisol and serum TSH values at night, suggesting that the excessive endogenous cortisol secretion might play a role in the derangement of TSH secretion.