住院的 COVID-19 患者中，下丘脑-垂体-甲状腺轴抑制与预后严重程度相关。
Suppression of the hypothalamic-pituitary-thyroid axis is associated with the severity of prognosis in hospitalized patients with COVID-19.
机构信息
Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Hubei provincial Clinical Research Center for Diabetes and Metabolic Disorders, Wuhan, China.
出版信息
BMC Endocr Disord. 2021 Nov 15;21(1):228. doi: 10.1186/s12902-021-00896-2.
BACKGROUND
The outbreak of severe acute respiratory syndrome novel coronavirus 2 (SARS-CoV-2) has spread rapidly worldwide. SARS-CoV-2 has been found to cause multiple organ damage; however, little attention has been paid to the damage to the endocrine system caused by this virus, and the subsequent impact on prognosis. This may be the first research on the hypothalamic-pituitary-thyroid (HPT) axis and prognosis in coronavirus disease 2019 (COVID-19).
METHODS
In this retrospective observational study, 235 patients were admitted to the hospital with laboratory-confirmed SARS-CoV-2 infection from 22 January to 17 March 2020. Clinical characteristics, laboratory findings, and treatments were obtained from electronic medical records with standard data collection forms and compared among patients with different thyroid function status.
RESULTS
Among 235 patients, 17 (7.23%) had subclinical hypothyroidism, 11 (4.68%) severe non-thyroidal illness syndrome (NTIS), and 23 (9.79%) mild to moderate NTIS. Composite endpoint events of each group, including mortality, admission to the ICU, and using IMV were observed. Compared with normal thyroid function, the hazard ratios (HRs) of composite endpoint events for mild to moderate NTIS, severe NTIS, subclinical hypothyroidism were 27.3 (95% confidence interval [CI] 7.07-105.7), 23.1 (95% CI 5.75-92.8), and 4.04 (95% CI 0.69-23.8) respectively. The multivariate-adjusted HRs for acute cardiac injury among patients with NTF, subclinical hypothyroidism, severe NTIS, and mild to moderate NTIS were 1.00, 1.68 (95% CI 0.56-5.05), 4.68 (95% CI 1.76-12.4), and 2.63 (95% CI 1.09-6.36) respectively.
CONCLUSIONS
Our study shows that the suppression of the HPT axis could be a common complication in COVID-19 patients and an indicator of the severity of prognosis. Among the three different types of thyroid dysfunction with COVID-19, mild to moderate NTIS and severe NTIS have a higher risk of severe outcomes compared with subclinical hypothyroidism.
背景
严重急性呼吸综合征新型冠状病毒 2（SARS-CoV-2）的爆发在全球迅速蔓延。SARS-CoV-2 已被发现会导致多器官损伤；然而，人们对这种病毒引起的内分泌系统损伤及其对预后的后续影响关注甚少。这可能是首例关于 2019 年冠状病毒病（COVID-19）中下丘脑-垂体-甲状腺（HPT）轴与预后的研究。
方法
在这项回顾性观察性研究中，我们从 2020 年 1 月 22 日至 3 月 17 日期间，共纳入了 235 名经实验室确诊的 SARS-CoV-2 感染住院患者。我们从电子病历中获取临床特征、实验室检查结果和治疗情况，并通过标准数据采集表进行比较，以比较不同甲状腺功能状态患者之间的差异。
结果
在 235 名患者中，17 名（7.23%）患者存在亚临床甲状腺功能减退症，11 名（4.68%）患者存在严重非甲状腺疾病综合征（NTIS），23 名（9.79%）患者存在轻度至中度 NTIS。观察各组的复合终点事件，包括死亡率、入住 ICU 和使用有创机械通气（IMV）的情况。与甲状腺功能正常的患者相比，轻度至中度 NTIS、严重 NTIS、亚临床甲状腺功能减退症的复合终点事件的危险比（HR）分别为 27.3（95%置信区间[CI] 7.07-105.7）、23.1（95% CI 5.75-92.8）和 4.04（95% CI 0.69-23.8）。非甲状腺功能衰竭（NTF）、亚临床甲状腺功能减退症、严重 NTIS 和轻度至中度 NTIS 患者中急性心脏损伤的多变量调整 HR 分别为 1.00、1.68（95% CI 0.56-5.05）、4.68（95% CI 1.76-12.4）和 2.63（95% CI 1.09-6.36）。
结论
我们的研究表明，HPT 轴抑制可能是 COVID-19 患者的常见并发症，也是预后严重程度的一个指标。在 COVID-19 三种不同类型的甲状腺功能障碍中，与亚临床甲状腺功能减退症相比，轻度至中度 NTIS 和严重 NTIS 发生严重结局的风险更高。
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