摘要目的 观察无原发甲状腺疾病的慢性阻塞性肺疾病(慢阻肺)急性加重患者血清甲状腺激素水平,探讨甲状腺激素水平与慢阻肺急性加重患者病情变化、病情严重程度及预后的关系.方法 选取2013—2014年于北京积水潭医院呼吸与危重症医学科因慢阻肺急性加重住院患者84例,其中男52例,女32例,年龄50~93岁,平均(78±10)岁,纳入同期健康体检者35名为对照组,其中男20名,女15名,年龄51~87岁,平均(73±11)岁.采用电化学发光法测定血清甲状腺激素水平:总三碘甲状腺原氨酸(triiodothyronin,TT3)、总甲状腺素(tetraiodothyronin,TT4)、游离三碘甲状腺原氨酸(free triiodothyronin,FT3)、游离甲状腺素(free tetraiodothyronin,FT4)、促甲状腺素(thyroid stimulating hormone,TSH).结果 慢阻肺急性加重患者治疗前、治疗后及对照组间血清TT4(80.03±18.31、88.97±17.80、113.37±21.23)、TT3(0.84±0.25、1.37±0.31、1.60±0.35)、FT3(2.57±0.73、3.49±0.64、4.21±0.75)进行两两比较,差异均有统计学意义(均P<0.05),治疗前明显低于治疗后,两者均明显低于对照组;另外,治疗前血清FT4(14.97±2.77)明显低于治疗后(16.26±2.54)及对照组(16.69±2.44,P<0.05);治疗后与对照组间比较,差异无统计学意义(P>0.05);慢阻肺急性加重Ⅰ型呼吸衰竭、Ⅱ型呼吸衰竭组血清TT4、TT3、FT4、FT3均明显低于无呼吸衰竭组(TT4:78.40±13.56、70.21±16.00、91.70±17.43;TT3:0.73±0.16、0.73±0.23、1.04±0.21;FT4:14.41±2.45、14.07±2.40、16.34±2.88;FT3:2.27±0.65、2.32±0.66、3.05±0.62,P<0.05);慢阻肺急性加重Ⅰ型呼吸衰竭组与Ⅱ型呼吸衰竭组间血清TT4、TT3、FT4、FT3比较,差异无统计学意义(P>0.05);慢阻肺急性加重治疗好转组血清TT3、FT3明显高于死亡组(TT3:0.90±0.25、0.68±0.18;FT3:2.76±0.67、2.07±0.68,P<0.05);两组间血清TT4(82.04±18.39、74.68±17.38)、FT4(15.25±2.77、14.23±2.68)、TSH(1.13±1.08、1.51±1.49)比较,差异无统计学意义(P>0.05).结论 血清甲状腺激素水平与慢阻肺急性加重病情变化相关.慢阻肺急性加重患者甲状腺激素水平减低;随着病情好转,甲状腺激素可有不同程度的恢复.缺氧、二氧化碳潴留可导致血清甲状腺激素水平的降低,其中缺氧的影响更为显著.血清甲状腺激素水平反映慢阻肺急性加重病情的严重程度,血清甲状腺激素水平,尤其是T3水平与慢阻肺急性加重患者预后密切相关,有利于预后的判断.

abstractsObjective To observe the alterations of serum thyroid hormone levels in acute exacerbation of chronic obstructive pulmonary disease ( AECOPD ) patients without thyroid disease and therefore to investigate the association between serum thyroid hormone levels and the severity and prognosis of AECOPD.Methods Serum thyroid hormone levels including TT 4,TT3,TSH,FT4 and FT3 were measured by chemiluminescence immunoassay in 84 hospitalized patients with AECOPD [ male 52, female 32, aged 50-93 years, average (78 ±10) years] and in 35 healthy subjects [male 20, female 15, aged 51-87 years, average (73 ±11) years] from 2013 to 2014.Results The serum TT4,TT3 and FT3 levels in AECOPD patients before therapy were significantly lower than those after therapy ( P <0.05 ) .The serum TT4,TT3 and FT3 levels in AECOPD post-therapy were significantly lower than those in the healthy control group(TT4:80 ±18, 89 ±18, 113 ±21;TT3:0.84 ±0.25,1.37 ±0.31,1.60 ±0.35; FT3:2.57 ±0.73, 3.49 ±0.64, 4.21 ±0.75, P<0.05).The serum FT4 level in AECOPD pre-therapy was significantly lower than that in AECOPD post-therapy and the control group(15.0 ±2.8,16.3 ±2.5,16.7 ±2.4, P<0.05). The difference of serum FT4 level between AECOPD post-therapy group and the control group was not statistically significant(P>0.05).The Serum TT4,TT3,FT4 and FT3 levels in type Ⅰ respiratory failure subgroup and type Ⅱ respiratory failure subgroup were both significantly lower than those in the non -respiratory failure subgroup(TT4:78 ±14, 70 ±16, 92 ±17;TT3:0.73 ±0.16,0.73 ±0.23, 1.04 ±0.21;FT4:14.4 ±2.4, 14.1 ±2.4, 16.3 ±2.9;FT3:2.27 ±0.65, 2.32 ±0.66, 3.05 ±0.62, P<0.05).The differences of serum TT4, TT3, FT4 and FT3 levels between type Ⅰrespiratory failure subgroup and type Ⅱrespiratory failure subgroup were not statistically significant ( P>0.05 ) .The serum TT3 and FT3 levels in the survival subgroup were significantly higher than those in the fatal subgroup ( TT3:0.90 ±0.25, 0.68 ± 0.18;FT3:2.76 ±0.67, 2.07 ±0.68, P<0.05).The differences of serum TT4(82 ±18, 75 ±17),FT4 (15.2 ±2.8, 14.2 ±2.7) and TSH(1.1 ±1.1, 1.5 ±1.5) levels between the 2 subgroups were not statistically significant(P>0.05).Conclusion Serum thyroid hormone levels are related to the condition of AECOPD.They are reduced in patients with AECOPD and can recover to different degrees as the primary disease improves.Hypoxia and carbon dioxide retention can result in decreased levels of serum thyroid hormones.Serum thyroid hormone levels are significantly associated with the severity and prognosis of patients with AECOPD .