老年慢性阻塞性肺疾病急性加重期或合并呼吸衰竭甲状腺激素变化及其临床意义

The significance of thyroid hormone levels in the elderly AECOPD patients

目的分析老年慢性阻塞性肺疾病急性加重期（AECOPD）患者或合并呼吸衰竭治疗前后甲状腺激素变化特点，探讨其临床意义。方法选择老年AECOPD患者40例，测定其治疗前、后及合并呼吸衰竭时甲状腺激素浓度；另选择与之年龄匹配的健康体检者40名，同期测定其甲状腺激素浓度作为对照比较。结果老年AECOPD患者血清三碘甲状腺原氨酸（T，）、血清游离三碘甲状腺原氨酸（FT3）、血清甲状腺素（T4）、血清游离甲状腺素（n）显著低于对照组：T3[（1．23±0．25）nmol／L与（1．70±0．29）nmol／L，t=3．97，P〈0．01]、FT3[（3．27±0．59）pmol／L与（4．48±0．95）pmol／L，t=6．09，P〈0．01]、T4[（109．30±17．73）nmol／L与（116．01±18．72）nmol／L，t=6．94，P〈0．01]、n[（15．11±2．37）pmol／L与（17．62±0．35）pmol／L，t=7．23，P〈0．01]；老年AECOPD合并呼吸衰竭者T3，FT3，T4，FT4低于未合并者：L[（1．08±0．10）nmol／L与（1．35±0．26）nmol／L，t=4．02，P〈0．01]、FT3[（2．89±0．41）pmol／L与（3．59±0．53）pmol／L，t=4．58，P〈0．01]、T4[（96．54±14．34）nmol／L与（115．20±26．10）nmol／L，t=2．71，P〈0．01]、FT4[（14．05±2．05）pmol／L与（17．11±1．55）pmol／L，t=5．37，P〈0；01]；老年AECOPD患者治疗后T3、FT3、T4浓度较治疗前升高，T3[（1．43±0．29）nmol／L与（1．25±0．25）nmol／L，t=2．93，P〈0．01]、FT3[（3．61±0．49）pmol／L与（3．26±0．60）pmol／L，t=2．73，P〈0．01]、T4[（114．31±10．99）nmol／L与（110．28±16．91）nmot／L，t=4．58，P〈0．01]。结论老年AECOPD患者T3、FT3、T4、FT4浓度降低；合并呼吸衰竭患者下降更为明显；积极治疗可提高甲状腺激素浓度，从而改善病情。甲状腺激素浓度的变化对老年AECOPD患者病情判断、疗效分析、预后估计有一定临床意义。

Objective To analyze the thyroid hormone levels before and after treatment in the patients with chronic obstructive pulmonary disease in acute exacerbation stage （AECOPD） with respiratory failure. Methods In 40 cases of elderly AECOPD patients with respiratory failure, the thyroid hormone levels before and after the treatment were measured. At the same time, the thyroid hormone levels in another 40 agematched healthy volunteers were determined. Results In elderly AECOPD patients, serum T3 , FT3 , T4 and FT4 were significantly lower than that of the control group ： T3 （ [ 1.23 ± 0. 25 ] nmol/L vs. [ 1.70 ± 0. 29 ] nmol/L, t = 3.97 ,P 〈 0.01 ）,FT3 （ [ 3.27 ± 0. 59 ] pmol/L vs. [ 4.48 ± 0. 95 ] pmol./L, t = 6.09, P 〈0. 01 ）, T4 （ [ 109. 3 ± 17. 73 ] nmol/L vs. [ 116. 01 ± 18. 72 ] nmol/L, t = 6. 94,P 〈 0. 01 ）, FT4 （ [ 15.11 ± 2. 37 ] pmol/L vs. [ 17.62 ± 0. 35 ] pmo1/L, t = 7. 23, P 〈 0.01 ） ; While in the elderly AECOPD patients with respiratory failure, the T3 , FT3, T4 and Fr4 were lower than those patients without respiratory failure ： T3 （ [ 1.08 ± 0. 10 ] nmol/L vs. [ 1.35 ± 0. 263 nmol/L,t = 4. 02, P 〈 0. 01 ）, FT3 （ [ 2. 89 ± 0. 41 ] pmol/L vs. [ 3.59 ± 0. 53 ] pmol/L, t = 4. 58, P 〈 0. 01） ,T4 （ [96. 54 ± 14. 34] nmol/L vs. [ 115.20 ± 26. 10] nmol/L,t = 2. 71,P 〈 0.01 ）, FT4 （ [ 14. 05 ± 2.05] pmol/L vs. [ 17.11 ± 1.55 ] pmol/L,t =5.37,P 〈0. 01 ）. In elderly AECOPD patients,the post-treatment T3, FT3 and T4 levels were elevated compared with that before treatment. The difference was statistically significant ：T3 （ [ 1.43 ± 0. 29 ] nmol/L vs. [ 1.25 ± 0. 25 ] nmol/L, t = 2. 93, P 〈 0. 01 ）, FT3 （ [ 3.61 ± 0. 49 ] pmol/L vs. [ 3.26 ± 0. 60 ] pmol/L,t = 2. 73,P 〈 0. 01 ）, T4 （ [ 114. 31 ± 10. 99 ] nmol/L vs. [ 110. 28 ± 16. 91 ] nmol/L,t = 4. 58. P 〈 0.01 ）. Conclusion In elderly AECOPD patients, the T3, FT3, T4 and FT4 levels are reduced and those in AECOPD patients with respiratory failure were decreased even more. Supportive treatment is able to enhance the thyroid hormone levels and improve the patients＇ condition. Therefore, the level of thyroid hormone in elderly AECOPD patients is useful to predict the patient＇s condition and prognosis.