慢性阻塞性肺病患者急性加重期甲状腺激素水平及影响因素分析

Analysis of thyroid hormone levels in patients of chronic obstructive pulmonary disease during acute exacerbation

目的比较分析慢性阻塞性肺病(chronic obstructive pulmonary disease,COPD)急性加重期和稳定期患者的甲状腺功能改变,探索COPD急性加重期甲状腺功能低下的相关影响因素。方法选取2016年1月至2017年1月在复旦大学附属浦东医院住院的COPD急性加重期患者198例作为研究对象,对照组为同期74例本院普外科住院的COPD稳定期患者。所有患者均询问入院前有无使用激素及吸烟史,入院第2天行血气分析并检测血甲状腺激素、C反应蛋白(C-reactive protein,CRP)和空腹血糖,病情稳定后行肺功能测定,并记录入院天数。结果急性加重期患者血清游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、三碘甲状腺原氨酸(triiodothyronine,TT3)、游离甲状腺素(free thyroxine,FT4)、甲状腺素(thyroxin,TT4)和促甲状腺激素(thyroid stimulating hormone,TSH)水平与对照组相似,且在正常参考值范围内。但两组患者血甲状腺激素指标均存在不同程度的下降,其中急性加重组的TT3降低发生率明显高于对照组(29.8%vs.13.5%,P<0.05)。COPD急性加重期患者FT3与年龄、CRP和用力肺活量(forced vital capacity,FVC)呈负相关(P均<0.05),和院外应用糖皮质激素史呈正相关(P<0.05)。结论 COPD急性加重期甲状腺功能明显低下,发生频率明显高于稳定期患者,表现为FT3、TT3降低为主,FT3降低程度与年龄、CRP、FVC及静脉应用激素有关。

Objective To compare and observe the changes of the thyroid function between the patients with acute exacerbation （AE） of chronic obstructive pulmonary disease （COPD） and with stable COPD, and to investigate the risk factors related to hypothyroidism in the patients with AECOPD. Methods History of using hormone and smoking were investigated in all patients before hospitalization. On the 2nd day in hospital, arterial blood gas analysis, thyroid hormones, C-reative protein （CRP） and fasting blood glucose in 198 patients with AECOPD recruited in Respiratory Diseases Unit of Pudong Hospital from Jan., 2016 to Jan., 2017, while 74 patients with stable COPD from the Department of General Surgery in the same hospital were designated as control group at the meantime. Stable patients received pulmonary function tests, and the days in hospital were recorded. Results The serum levels of free triiodothyronine （FT3）, triiodothyronine （TT3）, free thyroxine （FT4）, thyroxin （TT4） and thyroid stimulating hormone （TSH） in the patients with AECOPD were similar to those in the patients with stable COPD, all of which were among the normal range of the thyroid hormones. However, there was some patients from the two groups whose thyroid hormones were obviously decreased. Moreover, there were more patients in the group of AECOPD than in the group of stable COPD who had a reduced serum TT3 levels （23.79% vs. 13.50%, P〈0.05）. In the patients with AECOPD, there was a significant negative correlation between FT3 and age, CRP or forced vital capacity （FVC） in the patients with AECOPD （P〈0.05） while a pronounced positive correlation was found between FT3 and the history of intravenous administration of corticosteroids （P〈0.05）. Conclusions There is an obvious hypothyroidism in AECOPD patients, with a higher morbidity when compared with stable COPD, mainly manifested by a decrease in serum FT3 and TT3. The reduction in serum FT3 is related to age, CRP, FVC and the history of intravenous administration of corticosteroids.