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目的探讨慢性阻塞性肺疾病 (COPD)呼吸衰竭患者血清甲状腺激素的变化及其临床意义。方法应用放免法测定 4 2例COPD呼吸衰竭患者急性期与缓解期及 38例正常对照组血清三碘甲状腺原氨酸 (TT3 )、甲状腺素 (TT4)、促甲状腺素 (TSH)。同时检测动脉血中氧分压 (PaO2 ) ,并分析COPD呼吸衰竭患者PaO2 与TT3 、TT4和TSH的相关性。结果呼吸衰竭组急性发作期TT3 ,TT4水平均值显著低于缓解期及对照组 (P <0 .0 5及P <0 .0 1) ;呼吸衰竭死亡组TT3 ,TT4水平均值显著低于存活组 (P <0 .0 1)。COPD患者PaO2 与血清TT3 和TT4水平呈显著性正相关 ,与TSH呈显著性负相关 ,r分别为 0 .5 6 71、0 .5 346和 - 0 .4 935 ,(P <0 .0 5 )。结论COPD呼吸衰竭患者血清TT3 和TT4水平明显低于正常人 ,缺氧是导致COPD呼吸衰竭患者甲状腺激素变化的重要因素之一 ,监测血清中TT3 ,TT4的浓度有助于判断COPD危重程度和估计预后。
Objective To investigate the changes of serum thyroid hormones in patients with chronic obstructive pulmonary disease (COPD) respiratory failure and its clinical significance. Methods Serum triiodothyronine (TT3), thyroid hormone (TT4) and thyrotropin (TSH) in 42 patients with COPD respiratory failure during acute phase and remission and 38 normal controls were measured by radioimmunoassay. At the same time, PaO2 was measured in arterial blood and the correlation between PaO2 and TT3, TT4 and TSH in COPD patients with respiratory failure was analyzed. Results The average levels of TT3 and TT4 in acute episode of respiratory failure group were significantly lower than those in remission and control group (P <0.05 and P <0.01), respectively. The mean levels of TT3 and TT4 in respiratory failure group were significantly lower than those in survivor group (P <0. 01). There was a significant positive correlation between PaO2 and serum TT3 and TT4 levels in patients with COPD and a significant negative correlation with TSH (r = 0.56 71,0 .5 346 and -0.494, respectively, P <0.05 ). Conclusion Serum levels of TT3 and TT4 in COPD patients with respiratory failure are significantly lower than those in normal people. Hypoxia is one of the important factors that lead to the change of thyroid hormone in COPD patients with respiratory failure. Monitoring serum levels of TT3 and TT4 may be helpful in judging the severity and prognosis of COPD Prognosis.