Department of Family Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Fam Pract. 2021 Sep 25;38(5):630-636. doi: 10.1093/fampra/cmab027.
Hypothyroidism has a detrimental effect on the immune system, which may predispose patients to infection. However, evidence about the risk of developing either community- or hospital-acquired pneumonia in patients with hypothyroidism is scarce.
To evaluate the association between hypothyroidism and the risk of developing pneumonia.
This was a retrospective population-based cohort study from Taiwan's National Health Insurance Research Database. After 1:1 propensity score matching, 9749 patients (age ≥20 years) newly diagnosed with hypothyroidism between 2001 and 2014 and 9749 patients without hypothyroidism or other thyroid diseases were included in the hypothyroidism and non-hypothyroidism cohorts, respectively, and followed up until 2015. The development of pneumonia was defined as the primary outcome. Cox proportional hazards regression models were used to calculate the hazard ratios (HRs) of developing pneumonia between hypothyroidism and non-hypothyroidism cohorts after adjusting for age, sex and baseline comorbidities. To evaluate whether thyroxine replacement therapy (TRT) modified the risk for pneumonia, we divided patients with hypothyroidism into subgroups: patients who received TRT and those who did not.
Hypothyroidism was associated with a higher risk of pneumonia [adjusted HR (aHR) 1.38, 95% confidence interval (CI) 1.29-1.49, P < 0.001]. Patients with hypothyroidism who received TRT had a lower risk of pneumonia than patients who did not (aHR 0.85, 95% CI 0.76-0.93, P = 0.001). Similar results were obtained in the age- and sex-stratified analyses.
Clinically diagnosed hypothyroidism was independently associated with the risk of pneumonia. In patients with hypothyroidism, TRT was associated with a lower risk of pneumonia.
甲状腺功能减退症会对免疫系统造成损害，使患者更容易感染。然而，有关甲状腺功能减退症患者发生社区获得性或医院获得性肺炎风险的证据很少。
评估甲状腺功能减退症与肺炎发病风险之间的关系。
这是一项来自台湾全民健康保险研究数据库的回顾性基于人群的队列研究。经过 1:1 倾向评分匹配后，将 2001 年至 2014 年间新诊断为甲状腺功能减退症的 9749 例（年龄≥20 岁）患者和 9749 例无甲状腺功能减退症或其他甲状腺疾病的患者分别纳入甲状腺功能减退症组和非甲状腺功能减退症组，并随访至 2015 年。肺炎的发生定义为主要结局。使用 Cox 比例风险回归模型计算甲状腺功能减退症组和非甲状腺功能减退症组发生肺炎的风险比（HR），并调整年龄、性别和基线合并症。为了评估甲状腺素替代治疗（TRT）是否改变了肺炎的风险，我们将甲状腺功能减退症患者分为接受 TRT 和未接受 TRT 的亚组。
甲状腺功能减退症与肺炎风险增加相关（调整后的 HR[aHR]1.38，95%置信区间[CI]1.29-1.49，P<0.001）。接受 TRT 的甲状腺功能减退症患者发生肺炎的风险低于未接受 TRT 的患者（aHR 0.85，95%CI 0.76-0.93，P=0.001）。在年龄和性别分层分析中也得到了类似的结果。
临床诊断的甲状腺功能减退症与肺炎风险独立相关。在甲状腺功能减退症患者中，TRT 与肺炎风险降低相关。
