老年糖尿病社区获得性肺炎患者低T3综合征的临床分析

Clinical analysis of low T3 syndrome in elderly diabetic patients with community acqired pneumonia

目的:探讨低T3综合征与老年糖尿病社区获得性肺炎患者的相关性,为临床医师从多视角观察患者的预后提供依据。方法:选择老年糖尿病合并重症社区获得性肺炎患者58例设为A组,老年糖尿病合并普通肺炎患者50例设为B组,选取同期住院的无肺部感染糖尿病老年患者50例为对照组。比较3组患者低T3综合征与炎症标志物降钙素原(PTC)、C反应蛋白(CRP);糖代谢指标:糖化血红蛋白(HbA1c)、糖化白蛋白(AG)、血糖;氧合指数(PaO_2/FiO_2)及血气分析与病情的关系。结果:A组患者的T3水平比对照组明显降低,而FT4、TSH水平与对照组比较无明显差异。A组患者低T3与HbA1c、血糖、PCT及CRP成反比、与氧合指数成正比;与患者病情的严重程度成正比;与患者发生Ⅱ型呼吸衰竭成正比。结论:低T3综合征可以反映糖尿病重症肺炎患者的严重程度,当感染越重,低T3变化越显著,说明其改变与病情的严重程度有关,预后差,能指导临床医师对预后的判断。

Objective To investigate correlation between low T3 syndrome and community acquired pneumonia in elderly dia-betic patients, and provide an evidence for clinical physicians to observe the prognosis of the patients from multiple perspectives. Methods ： 58 elderly diabetic patients with severe community acquired pneumonia （ CAP） were selected and set as group A, 50 elderly diabetic inpatients without severe CAP at the same period was used as group B and 50 elderly patients without diabetes mellitus and pneumonia were chosen as control group. The correlations were analyzed among low T3 syndrome and inllammatory biomarkers such as procalcitonin （PCT） and C-reactive protein （CRP） , indicators of glucose metabolism such as glycosylated hemoglobin（HbA1c） , gly-cated albumin （ GA） and blood glucose, oxygenation index （PaO2 / FiO2 ） , blood gas analysis and disease severity of the three groups. Results ： The T3 level of group A was significantly lower than that of control group, while the FT4 and TSH levels were not significantly different from those of control group. Low T3 of group A was negatively correlated with HbA1c, blood glucose, PCT and CRP, but was positively related with oxygenation index, disease severity and the incidence of type II respiratory failure. Conclusions： Low T3 syn-drome can reflect the severity of diabetes with severe pneumonia： the more severe the infection is, the more significant change of T3 is, suggesting the change of T3 is related to the disease severity and poor prognosis. It can be used by clinicians to judge prognosis.