AECOPD患者住院期间低T3综合征对预后的影响

The impact of low-T3 syndrome in acute exacerbation of chronic obstructive pulmonary disease on the prognosis of patients

目的评价慢性阻塞性肺疾病急性加重期（AECOPD）患者住院期间低T3综合征对预后的影响。方法选取338例AECOPD患者，入院时检测血甲状腺激素，分别对低T3综合征患者和正常甲状腺功能者进行临床症状严重程度分级及肺功能分期，比较不同分级及分期的分布情况；入院后统计并比较两种患者的症状缓解时间、机械通气人数以及住院期间病死率。结果诊断为低113综合征68例，临床症状分级：Ⅰ级8例，Ⅱ级18例，Ⅲ级42例，各分级患者分布的差异均有统计学意义（均P〈0．01）；肺功能分期：Ⅰ～Ⅱ期（轻度）22例，Ⅲ期（中度）18例，lV期（重度）28例，各分期患者分布的差异无统计学意义（P〉0．05）。68例在住院期间死亡12例，余56例在恢复期复查仍符合低T3综合征诊断3例，另53例全部恢复正常，恢复期低T3综合征发生率（3／56，86％）显著低于急性期（68／338，20．1％）（P〈0．01）。与正常甲状腺功能者比较，低T3综合征患者临床症状Ⅲ级患者所占比例显著升高（P〈0．01）、症状缓解时间明显较长（P〈0．05）、住院期间病死率显著升高（P〈0．01）。结论AECOPD合并低T3综合征时，需要行机械通气支持治疗的患者明显增加，其症状缓解时间延长，病死率升高；合并低T3综合征是急性生理功能紊乱极重的表现，其下降程度可作为观察疾病严重程度和预测病死率的指标之一。

Objective To evaluate the impact of low-T3 syndrome in acute exacerbation of chronic obstructive pulmonary disease （AECOPD） during hospitalization on the prognosis of patients. Methods Three hundred and thirty eight patients with AECOPD were divided into low-T3 syndrome group （n=68） and normal thyroid function group （n=270） based on blood test of thyroid steroid. The clinical symptom severity, the grading and staging of lung function were analyzed; the remission days, numbers of ventilation and mortality of the two groups were compared. Results In 68 cases of low T3 syndrome, according to clinical symptoms 8 cases were classified as grade Ⅰ, 18 grade Ⅱ, 42 grade Ⅲ. According to lung function, 22 cases were classified as stage Ⅰ - Ⅱ （mild）, 18 stage Iit （moderate）, 28 stage Ⅳ （severe）. In patient of low T3 syndrome 12 died during hospitalization, in 56 surviving patients 3 cases were still diagnosed as low T3 syndrome in the recovery; the remaining 53 cases had recovery to normal. The recovery rate of low T3 syndrome （3/56, 8.6%） was significantly lower than the acute stage （68/338, 20.1%） （P〈0.01）. Compared with patients of normal thyroid function, the proportion of clinical symptoms stage III in patients with low T3 syndrome were significantly higher （P〈0.01）; the remission days were longer （P〈0.05） and the mortality was higher （P〈0. 01）. Conclusion The degree of low T3 syndrome in patients of AECOPD is an indicator for the disease severity and prognosis.