Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
J Clin Gastroenterol. 2013 Feb;47(2):153-9. doi: 10.1097/MCG.0b013e318254ea8a.
This study was designed to investigate the clinical features of nonthyroidal illness syndrome (NTIS) compared with euthyroid patients in Crohn's disease (CD), to explore the etiology of NTIS in CD, to evaluate the clinical outcomes of NTIS patients, and to inspect the correlation of clinical variables and NTIS, and their ability of differentiating NTIS from euthyroid patients.
NTIS has been described for more than 30 years. However, only few studies focused on the relationship between NTIS and CD. The incidence, underlying pathogenesis, clinical outcomes, and correlation with other inflammatory disease severity and nutritional variables of NTIS in CD have not been completely established.
Prospectively, 44 CD patients were enrolled. Medical records and various laboratory values (including thyroidal, nutritional, and inflammatory variables) were collected in all participants.
The incidence of NTIS in CD was 36.4%. Albumin, Acute Physiology and Chronic Health Evaluation II score, and Crohn's Disease Activity Index score in NTIS group were statistically different from those in euthyroid group. A decreased sum activity of deiodinases and a reduced ratio of TT4/FT4 were observed in NTIS group. Duration of hospitalization was significantly longer for NTIS patients than euthyroid patients. Albumin was confirmed as a protective factor of NTIS in CD. Receiver operating characteristic curve analysis demonstrated the differentiating capacity of albumin, suggesting 37.6 g/L as optimal cut-off value with sensitivity and specificity of 81.3% and 79.2%, respectively.
NTIS was a common complication in CD. NTIS patients showed worse nutrition status and clinical outcome, and more critical disease activity and severity compared with euthyroid patients. A hypodeiodination condition and a potential thyroid-hormone-binding dysfunction may play a role in the etiology of NTIS in CD. Albumin was a meaningful protective and distinguishing marker of NTIS in CD.
本研究旨在探讨与甲状腺功能正常的克罗恩病（CD）患者相比，非甲状腺疾病综合征（NTIS）患者的临床特征，探索 CD 中 NTIS 的病因，评估 NTIS 患者的临床结局，以及检查临床变量与 NTIS 的相关性及其对 NTIS 与甲状腺功能正常患者的鉴别能力。
NTIS 已经被描述了 30 多年。然而，只有少数研究关注 NTIS 与 CD 之间的关系。NTIS 在 CD 中的发病率、潜在发病机制、临床结局以及与其他炎症性疾病严重程度和营养变量的相关性尚未完全确定。
前瞻性纳入 44 例 CD 患者。所有参与者均收集病历和各种实验室值（包括甲状腺、营养和炎症变量）。
CD 中 NTIS 的发病率为 36.4%。NTIS 组的白蛋白、急性生理学和慢性健康评估 II 评分和克罗恩病活动指数评分与甲状腺功能正常组有统计学差异。NTIS 组观察到脱碘酶的总活性降低和 TT4/FT4 比值降低。NTIS 患者的住院时间明显长于甲状腺功能正常患者。白蛋白被确认为 CD 中 NTIS 的保护因素。ROC 曲线分析表明白蛋白具有区分能力，提示 37.6g/L 为最佳截断值，其敏感性和特异性分别为 81.3%和 79.2%。
NTIS 是 CD 的常见并发症。与甲状腺功能正常患者相比，NTIS 患者的营养状况和临床结局更差，疾病活动度和严重程度更高。潜在的甲状腺激素结合功能障碍可能在 CD 中 NTIS 的发病机制中起作用。白蛋白是 CD 中 NTIS 的有意义的保护和区分标志物。
