Cheng Y, Dai L, Xia G G
Department of Respiratory Disease, Beijing Jishuitan Hospital, Beijing, 100035, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2016 Dec 12;39(12):939-943. doi: 10.3760/cma.j.issn.1001-0939.2016.12.007.
To observe the alterations of serum thyroid hormone levels in acute exacerbation of chronic obstructive pulmonary disease (AECOPD) patients without thyroid disease and therefore to investigate the association between serum thyroid hormone levels and the severity and prognosis of AECOPD. Serum thyroid hormone levels including TT4, TT3, TSH, FT4 and FT3 were measured by chemiluminescence immunoassay in 84 hospitalized patients with AECOPD [male 52, female 32, aged 50-93 years, average (78±10) years] and in 35 healthy subjects [male 20, female 15, aged 51-87 years, average (73±11) years] from 2013 to 2014. The serum TT4, TT3 and FT3 levels in AECOPD patients before therapy were significantly lower than those after therapy(<0.05). The serum TT4, TT3 and FT3 levels in AECOPD post-therapy were significantly lower than those in the healthy control group(TT4: 80±18, 89±18, 113±21; TT3: 0.84±0.25, 1.37±0.31, 1.60±0.35; FT3: 2.57±0.73, 3.49±0.64, 4.21±0.75, <0.05). The serum FT4 level in AECOPD pre-therapy was significantly lower than that in AECOPD post-therapy and the control group(15.0±2.8, 16.3±2.5, 16.7±2.4, <0.05). The difference of serum FT4 level between AECOPD post-therapy group and the control group was not statistically significant(>0.05). The Serum TT4, TT3, FT4 and FT3 levels in type Ⅰ respiratory failure subgroup and type Ⅱ respiratory failure subgroup were both significantly lower than those in the non-respiratory failure subgroup(TT4: 78±14, 70±16, 92±17; TT3: 0.73±0.16, 0.73±0.23, 1.04±0.21; FT4: 14.4±2.4, 14.1±2.4, 16.3±2.9; FT3: 2.27±0.65, 2.32±0.66, 3.05±0.62, <0.05). The differences of serum TT4, TT3, FT4 and FT3 levels between type Ⅰ respiratory failure subgroup and type Ⅱ respiratory failure subgroup were not statistically significant(>0.05). The serum TT3 and FT3 levels in the survival subgroup were significantly higher than those in the fatal subgroup(TT3: 0.90±0.25, 0.68±0.18; FT3: 2.76±0.67, 2.07±0.68, <0.05). The differences of serum TT4(82±18, 75±17), FT4(15.2±2.8, 14.2±2.7) and TSH(1.1±1.1, 1.5±1.5) levels between the 2 subgroups were not statistically significant(>0.05). Serum thyroid hormone levels are related to the condition of AECOPD. They are reduced in patients with AECOPD and can recover to different degrees as the primary disease improves. Hypoxia and carbon dioxide retention can result in decreased levels of serum thyroid hormones. Serum thyroid hormone levels are significantly associated with the severity and prognosis of patients with AECOPD.
观察无甲状腺疾病的慢性阻塞性肺疾病急性加重期（AECOPD）患者血清甲状腺激素水平的变化，从而探讨血清甲状腺激素水平与AECOPD严重程度及预后的关系。采用化学发光免疫分析法测定了2013年至2014年期间84例住院AECOPD患者[男52例，女32例，年龄50 - 93岁，平均（78±10）岁]和35例健康对照者[男20例，女15例，年龄51 - 87岁，平均（73±11）岁]的血清甲状腺激素水平，包括总甲状腺素（TT4）、总三碘甲状腺原氨酸（TT3）、促甲状腺激素（TSH）、游离甲状腺素（FT4）和游离三碘甲状腺原氨酸（FT3）。AECOPD患者治疗前血清TT4、TT3和FT3水平显著低于治疗后（<0.05）。AECOPD治疗后血清TT4、TT3和FT3水平显著低于健康对照组（TT4：80±18、89±18、113±21；TT3：0.84±0.25、1.37±0.31、1.60±0.35；FT3：2.57±0.73、3.49±0.64、4.21±0.75，<0.05）。AECOPD治疗前血清FT4水平显著低于治疗后及对照组（15.0±2.8、16.3±2.5、16.7±2.4，<0.05）。AECOPD治疗后组与对照组血清FT4水平差异无统计学意义（>0.05）。Ⅰ型呼吸衰竭亚组和Ⅱ型呼吸衰竭亚组的血清TT4、TT3、FT4和FT3水平均显著低于非呼吸衰竭亚组（TT4：78±14、70±16、92±17；TT3：0.73±0.16、0.73±0.23、1.04±0.21；FT4：14.4±2.4、14.1±2.4、16.3±2.9；FT3：2.27±0.65、2.32±0.66、3.05±0.62，<0.05）。Ⅰ型呼吸衰竭亚组与Ⅱ型呼吸衰竭亚组血清TT4、TT3、FT4和FT3水平差异无统计学意义（>0.05）。存活亚组的血清TT3和FT3水平显著高于死亡亚组（TT3：0.90±0.25、0.68±0.18；FT3：2.76±0.67、2.07±0.68，<0.05）。两亚组血清TT4（82±18、75±17）、FT4（15.2±2.8、14.2±2.7）和TSH（1.1±1.1、1.5±1.5）水平差异无统计学意义（>0.05）。血清甲状腺激素水平与AECOPD病情相关。AECOPD患者甲状腺激素水平降低，且随着原发病好转可不同程度恢复。缺氧和二氧化碳潴留可导致血清甲状腺激素水平降低。血清甲状腺激素水平与AECOPD患者的严重程度及预后显著相关。
