慢性阻塞性肺疾病患者甲状腺激素水平变化的临床分析

摘要

目的 观察慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)患者急性加重期和缓解期的血清甲状腺激素变化及其与血PaO2、PaCO2的相关性.方法 选择115例COPD急性加重期患者,入院时在未吸氧状态下检测动脉血气分析,于入院时和治疗1周后缓解时分别检测血清甲状腺素(T4)、游离T4(FT4)、三碘甲状腺原氨酸(T3)、游离T3(FT3)及促甲状腺激素(TSH)含量,并与33例正常健康人比较.结果 COPD急性加重期患者血清中T3、FT3、T4、FT4均较对照组显著下降(P<0.01),治疗1周后,33例病情缓解者上述指标均明显改善(P<0.01),但仍低于正常对照组(P<0.01).血清T3 、T4与PaO2呈正相关,血清T3与PaCO2呈负相关,TSH在各组中变化无统计学意义.结论 COPD患者甲状腺激素水平有明显变化,与PaO2、PaCO2变化有一定相关性,动态观察血清甲状腺素的变化,对COPD急性加重期患者的病情轻重判断具有一定的临床参考价值.%Objective To observe the changes in thyroid hormone level before and after the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease( AECOPD ), and to investigate the relationship between thyroid hormone and PaO2 , PaCO2. Methods Clinical data of 115 inpatients with acute exacerbation of chronic obstructive pulmonary disease were collected, arterial blood gas detected ahead of oxygen aspiration at admission. TH levels of 33 controls were compared with AECOPD patients at admission and one week after treatment. Results The serum T3, FT3, T4 , and FT4 levels were significantly lower in acute exacerbation phase of COPD patients than those in the normal control group( P<0.01 ). The serum T3 ,FT3 ,T4 and FT4 of 33 cases with AECOPD after remittence all increased distinctly P < 0.01 ), however, it was still lower than the normal control group( P < 0. 01 ). The serum T3 and T4 were positively correlated with PaO2. The serum T3 was negatively correlated with PaCO2. Conclusion There is thyroid hormone level variation in patients with AECOPD. Hypoxia and carbon dioxide retention can affect thyroid hormone levels to some degree, which gradually improved with the remittence of disease. Thyroid hormone levels also reflect the severity of the disease to a certain degree. The dynamic observation of serum TH changes has some clinical reference value for judging the severity of the disease in AECOPD patients.