慢性阻塞性肺疾病急性加重期患者甲状腺功能研究

Thyroid Function in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)患者的甲状腺功能。方法选取2014—2016年北京积水潭医院呼吸内科收治的AECOPD患者214例,为观察组;选取同期在本院接受体检的健康者56例,为对照组。分别于对照组体检当天、观察组入院次日和出院前1天,检测其8:00的血清总三碘甲状腺原氨酸(TT_3)、总甲状腺素(TT_4)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)水平以及8:00、16:00、24:00的血清促甲状腺激素(TSH)水平。结果观察组共有血清甲状腺激素水平异常患者168例(78.5%),包括亚临床甲状腺功能减退患者10例(6.0%)、非甲状腺疾病综合征(NTIS)患者158例(94.0%),NTIS患者中低三碘甲状腺原氨酸(T_3)综合征、低甲状腺素(T_4)综合征、高T_4综合征分别为119例(75.3%)、34例(21.5%)、5例(3.2%)。治疗前和治疗后,观察组存活者(n=188)血清TT_3、TT_4、FT_3水平均低于对照组,差异有统计学意义(P<0.05);观察组存活者与对照组血清FT_4水平比较,差异均无统计学意义(P>0.05)。治疗前,观察组存活者血清TSH水平低于对照组,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P<0.05);组别和时间在血清TSH水平上存在交互作用(P<0.05);其中,观察组存活者24:00血清TSH水平低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组存活者与对照组血清TSH水平比较,差异无统计学意义(P>0.05);不同时间点比较,差异有统计学意义(P<0.05);组别和时间在血清TSH水平上无交互作用(P>0.05);其中,观察组存活者24:00血清TSH水平高于同期治疗前,差异有统计学意义(P<0.05)。结论AECOPD患者存在甲状腺功能异常,TSH夜间分泌峰值缺失,垂体-甲状腺轴功能紊乱。

Objective To study the status of thyroid function in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods The enrolled 270 participants were all from Beijing Jishuitan Hospital,including 214 cases of AECOPD(observation group)receiving inpatient treatment in Respiratory Department and 56 healthy volunteers(control group)underwent physical examination,during 2014-2016.Blood sample collection was performed at 8:00 for detecting serum thyroid hormones〔triiodothyronine(TT3),total thyroxine(TT4),free triiodothyronine(FT3),free thyroxine(FT4)and thyroidstimulating hormone(TSH)〕,and at 16:00,24:00 respectively for measuring the TSH levels on the day undergoing physical examination in the control group,and on the second day after admission(before treatment)and the day before discharge(after treatment)in the observation group.Results In the observation group,168 patients(78.5%)were identified with abnormal serum thyroid hormone levels,including 10 cases(6.0%)of subclinical hypothyroidism,and 158 cases(94.0%)of nonthyroid illness syndrome(NTIS).Among NTIS patients,119(75.3%)were found with normal T4 but decreased T3,34(21.5%)with decreased T3 and T4,and 5(3.2%)with elevated T4.The serum TT3,TT4,FT3 levels in AECOPD survivors(n=188)measured either before or after treatment were lower compared with the control group(P<0.05).However,serum FT4 levels in the observation group measured either before or after treatment was similar to that of the control group(P>0.05).The average TSH level was much lower in the AECOPD survivors before receiving treatment compared with that of the controls(P<0.05);moreover,TSH levels in the blood sampled at each time point differed significantly between the groups(P<0.05);serum TSH level was affected significantly by the interaction between the prevalence of AECOPD and sampling time point(P<0.05),specifically,the TSH level at 24:00 in the AECOPD survivors was lower than that of the controls(P<0.05).After receiving treatment,the AECOPD survivors showed similar average TSH level to that of the controls(P>0.05),but the TSH levels in the blood sampled at each time point still varied significantly between the groups(P<0.05);serum TSH level was no longer affected significantly by the interaction between the prevalence of AECOPD and sampling time point(P<0.05);at 24:00,AECOPD survivors demonstrated higher TSH level compared with before treatment(P<0.05).Conclusion Some AECOPD patients were found with thyroid dysfunction,and they lacked nocturnal peak of TSH,indicating that they might also have hypothalamic-pituitary-thyroid axis.