慢性阻塞性肺疾病急性加重期低T_3综合征及其临床意义

The clinical low T_3 syndrome in the patients with acute exacerbations of chronic obstructive pulmonary disease

目的 :了解低T3综合征在慢性阻塞性肺疾病急性加重患者中的发生情况及其与疾病严重程度的相关性和预后的关系。方法 :选取AECOPD患者152例,根据动脉血气及临床表现分为无呼吸衰竭和右心功能衰竭组(A组)54例、有呼吸衰竭无右心功能衰竭组(B组)42例、无呼吸衰竭有右心功能衰竭组(C组)31例、有呼吸衰竭及右心功能衰竭组(D组)25例。应用化学发光法测定各组血清甲状腺激素水平。结果 :低T3综合征发病率为18.42%;通过分类比较,B、C组分别和A组相比,D组分别与A组、B组、C组相比,TT3、FT3下降,差异有统计学意义;合并呼吸衰竭者(B组、D组,67例)较未合并呼吸衰竭者(A组、C组,85例)TT3、FT3下降,差异有统计学意义;152例患者,死亡9例,病情恶化自动出院12例,其余患者(131例)好转出院,与好转出院者相比,死亡组与自动出院组TT3、FT3下降,差异有统计学意义。以上所有比较结果 TT4、FT4、TSH差异无统计学意义。结论 :血清甲状腺激素水平在AECOPD患者中有不同程度的下降,监测甲状腺功能有助于判断AECOPD患者的病情危重程度及预测预后。

Objective： To study the relationship of disease severity and prognosis between low T3 syndrome and acute exacerbations of chronic obstructive pulmonary disease （AECOPD）. Methods：One hundred and iffty-two patients with AECOPD were divided into 4 groups based on their arterial blood partial oxygen pressure/carbon dioxide pressure and clinical manifestation：group A without respiratory failure and right heart failure （n=54）;group B with respiratory failure but without right heart failure （n=42）;group C with right heart failure but without respiratory failure （n=31）;group D with respiratory failure and right heart failure （n=25）. Serum levels of thyroid hormones were measured by chemiluminescence method. Results：The morbidity of low T3 syndrome was 18.42%. In group B and group C, levels of TT3, FT3 were signiifcantly lower than those in group A. In group D, serum levels of TT3, FT3 were signiifcantly lower than those in the other three groups. The serum levels of TT3, FT3 were signiifcantly lower in 67 cases with respiratory failure than in 85 cases without respiratory failure. Nine patients died, and 12 patients were discharged themselves and the others were improved. In died and discharged themselves groups, serum levels of TT3, FT3 were signiifcantly lower than those in the improved subgroup. All the comparisons of TT4, FT4 and TSH were not statistically signiifcant. Conclusion：Serum levels of thyroid hormone have different degrees of decline in patients with AECOPD. Monitoring of serum levels of thyroid hormones may be useful in predicting disease severity and outcome for patients with COPD.