呼吸衰竭患者甲状腺激素水平的变化及临床意义
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摘要
目的：比较呼吸衰竭患者的甲状腺激素水平及血气分析的变化，探讨氧分压和二氧化碳分压对甲状腺激素水平的影响。
方法：选择我院呼吸科、ICU住院呼吸衰竭患者70例，急性组30例，慢性组40例，健康对照组30例，于未吸氧时取桡动脉血1ml行血气分析，清晨空腹安静状态下取静脉血3ml查甲状腺功能，观察FT_3、FT_4、TT_3、TT_4和TSH的变化，分析呼吸衰竭患者PaO_2、PaCO_2和甲状腺激素的相关关系。
结果：急性、慢性呼吸衰竭组FT_3、TT_3、TT_4均明显低于健康对照组(P＜0.01)，但急性呼衰组与慢性呼衰组无差别(P＞0.05)；急性呼衰组FT_4明显低于健康对照组(P＜0.05)，而慢性呼衰组与健康对照组无差别；急性组、慢性组和对照组三组TSH无差别(P＞0.05)。急性呼衰组与慢性呼衰组PaO_2无差别，慢性呼衰组PaCO_2明显高于急性呼衰组。急性呼衰组患者的TT_3与PaO_2呈显著性正相关，r为0.861，P＜0.01，FT_3、FT_4、TT_4、TSH均与PaO_2无显著性相关，急性组患者的甲状腺激素水平与PaCO_2无显
著性相关，P>0.05。慢性呼衰组患者FT3、
呈显著性正相关，r分别为0.757、O，387、
FT魂、TT。与Pa 02
0 .7 85，P< 0 .05;
FT3、TT。与PaCO:呈显著性负相关，:分别为一0.573、一0.429，
P<0.05;TT;、TSH与PaOZ、PaCOZ均无显著性相关，P>0.05。
结论:本研究表明，呼吸衰竭患者均可出现甲状腺激
素水平减低，甲状腺激素的变化在一定程度上受PaO:降
低、PaCO:升高的影响，血清T3、T4的测定有助于评佑呼
吸衰竭病人的病情。
Object: To compare measurements of thyroid function and blood gas analysis between patients with acute and chronic respiratory failure. The purpose of this study was to investigate the relation between thyroid hormones and PaO2, PaCO2. Methods : Retrospective, observational study at the medical/intensive care unit(ICU) in our hospital, 70 patient were admitted in the study. Immediately, we took blood sample for EGA without inhaled oxygen at admission, and at 8:00 hours on the subsequent day, we took blood samples for measuring serum total (TT4) and free thyroxine (FT4), total (TT3) and free tri-iodothyroxine(FT3), thyrotropin (TSH)concentrations. Results: The value of FT3, TT3,TT4 in patients with respiratory failure were showed obviously lower than control group, there were no difference between acute and chronic groups. In acute group, FT4 was lower than control group, but hadn't difference between chronic and control groups. No differ among the three groups serum TS
H existed. PaO2 did not differ in two groups, PaCO2 were
significantly more in chronic RF group than acute RF group. PaO2 in patient with acute and chronic RF had positive relation with TT3, PaCO2 in the patients with chronic RF had a negative relation with FT3 TT3CP<0.05). TT4 and TSH in the patients with HF had no relation to PaO2 and PaCO2 (P>0.05). Conclusion: l.In patients with RF SES take place, 2.SES seems to related to the decrease of PaO2 and increase PaCO2; statistically significant positive relation between TT3 and PaO2 in patients, negative correlation between FT3) TT3 and PaCO2 in chronic RF. The fact suggests to measuring thyroid hormones concentration is useful, it can evaluate the state of illness in patients with RF.
方法：选择我院呼吸科、ICU住院呼吸衰竭患者70例，急性组30例，慢性组40例，健康对照组30例，于未吸氧时取桡动脉血1ml行血气分析，清晨空腹安静状态下取静脉血3ml查甲状腺功能，观察FT_3、FT_4、TT_3、TT_4和TSH的变化，分析呼吸衰竭患者PaO_2、PaCO_2和甲状腺激素的相关关系。
结果：急性、慢性呼吸衰竭组FT_3、TT_3、TT_4均明显低于健康对照组(P＜0.01)，但急性呼衰组与慢性呼衰组无差别(P＞0.05)；急性呼衰组FT_4明显低于健康对照组(P＜0.05)，而慢性呼衰组与健康对照组无差别；急性组、慢性组和对照组三组TSH无差别(P＞0.05)。急性呼衰组与慢性呼衰组PaO_2无差别，慢性呼衰组PaCO_2明显高于急性呼衰组。急性呼衰组患者的TT_3与PaO_2呈显著性正相关，r为0.861，P＜0.01，FT_3、FT_4、TT_4、TSH均与PaO_2无显著性相关，急性组患者的甲状腺激素水平与PaCO_2无显
著性相关，P>0.05。慢性呼衰组患者FT3、
呈显著性正相关，r分别为0.757、O，387、
FT魂、TT。与Pa 02
0 .7 85，P< 0 .05;
FT3、TT。与PaCO:呈显著性负相关，:分别为一0.573、一0.429，
P<0.05;TT;、TSH与PaOZ、PaCOZ均无显著性相关，P>0.05。
结论:本研究表明，呼吸衰竭患者均可出现甲状腺激
素水平减低，甲状腺激素的变化在一定程度上受PaO:降
低、PaCO:升高的影响，血清T3、T4的测定有助于评佑呼
吸衰竭病人的病情。
Object: To compare measurements of thyroid function and blood gas analysis between patients with acute and chronic respiratory failure. The purpose of this study was to investigate the relation between thyroid hormones and PaO2, PaCO2. Methods : Retrospective, observational study at the medical/intensive care unit(ICU) in our hospital, 70 patient were admitted in the study. Immediately, we took blood sample for EGA without inhaled oxygen at admission, and at 8:00 hours on the subsequent day, we took blood samples for measuring serum total (TT4) and free thyroxine (FT4), total (TT3) and free tri-iodothyroxine(FT3), thyrotropin (TSH)concentrations. Results: The value of FT3, TT3,TT4 in patients with respiratory failure were showed obviously lower than control group, there were no difference between acute and chronic groups. In acute group, FT4 was lower than control group, but hadn't difference between chronic and control groups. No differ among the three groups serum TS
H existed. PaO2 did not differ in two groups, PaCO2 were
significantly more in chronic RF group than acute RF group. PaO2 in patient with acute and chronic RF had positive relation with TT3, PaCO2 in the patients with chronic RF had a negative relation with FT3 TT3CP<0.05). TT4 and TSH in the patients with HF had no relation to PaO2 and PaCO2 (P>0.05). Conclusion: l.In patients with RF SES take place, 2.SES seems to related to the decrease of PaO2 and increase PaCO2; statistically significant positive relation between TT3 and PaO2 in patients, negative correlation between FT3) TT3 and PaCO2 in chronic RF. The fact suggests to measuring thyroid hormones concentration is useful, it can evaluate the state of illness in patients with RF.
引文
1．陈敏章主编．中华内科学，第1版．北京：人民卫生出版社，1999，1759
2．中华医学会呼吸病学会慢性阻塞性肺疾病学组．慢性阻塞性肺疾病诊治指南，中华结核和呼吸杂志，2002，25(8)：453-458
3．陈灏珠主编．实用内科学，第11版．北京：人民卫生出版社，2001，2553
4. Inder J. Chopra. Euthyroid sick syndrome: Is It a Misnomer? J Clin Endocrinol Metab. 1997, 82(2): 329-334
5. Di Napoli M, Reda G, Zannoni G, et al. The euthyroid sick symdrome. Its incidence and clinical significance in an internal medicine department. Minerva Med 1994 Apr; 85(4): 161-5
6．柳涛，王保法，王晓红，等．甘草对慢性阻塞性肺疾病患者糖皮质激素受体的影响．中华结核和呼吸杂志，1999，22：595-597
7. Reinhardt W, Mocker V, Jockenhovel F, et al. Influence of coronary bypass surgery on thyroid hormone parameter. Horm Res, 1997,47:1-8
8. Monig H, Arendt T, Meyer M, et al. Activation of the hypothalaamo-pituitary-adrenal axis in response to septic or non-septic diseases-implacations for the euthyroid sick syndrome. Intensive Care Med, 1999, 25: 1402-1406.
9. Boelen A, Mass MA, Lowik CW, et al. Induced illness in interleukin-6(IL-6)knock-out mice; a causal role of IL-6 in the
development of the low 3,5,3'-triiodothyroinine syndrome. Endocrinology, 1996, 137:5250-5254．
10． Chopra IJ, Huang TS, Beredo A, Solomon DH, Chua Teco GN. Serum thyroid hormone binding inhibitor in nonthyroid illnesses. Metabolism. 1986,35:152-159．
11． Chopra IJ, Chua Teco GN, Nguyen AH, Solomon DH. In search of an inhibitor of thyroid hormone binding to serum proteins in nonthyroid illnesses. J Clin Endocrinol Metab. 1979, 49:63-69．
12． Chopra IJ, Huang TS, Solomon DH, Chaudhary GN. The role of thyroxine (T4) -binding serum proteins in oleic acid induced increase in free T4 in nonthyroidal illness. J Clin Endocrinol Metab. 1986, 63:776-779．
13． Mendel C, Frost P, Cavalieri RR. Effect of free fatty acids on the concentration of free thyroxine in human serum: the role of albumin. J Clin Endocrinol Metab. 1986,63:1394-1399．
14． Gray-Donald K, Gibbons L, Shapiro SH, et al. Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1996,153:961
15． 罗勇，徐卫国，姚迪，等．慢性阻塞性肺病营养状态与甲状腺激素相关性研究，上海医学, 2000, 23 (5) : 273-275
16. Siafakas NM, Milona I, Salesiotou V, et al. Respiratory muscle strength in hyperthyroidism before and after treatment. Am Rev Respir Dis, 1992, 146: 1025
17．吴斌，宋泽庆，李文．缺氧对慢性肺心病患者甲状腺功能的影响，中国实用内科杂志，2002，22(3)：156-158
18．方佩华，丁雅静，陈秉忠，等．各种生理、病理状态下血清甲状腺激素含量的变化——1140例测定结果分析[J]．中华核医学杂志，1983，3(4)：198-200．
19．张彦华，陈小妹．慢性肺心病病人的甲状腺激素变化．天津医药，1993，2，88-89
20. Wawrzynska L, Sakowicz A, Filipecki S. Euthyroid sick syndrome in patients with respiratory failure. Pneumonol Alergol Pol. 1996; 64 Suppl 2:193-9
21. Di Napoli M, Reda G, Zannoni G, et al. The euthyroid sick syndrome. Its incidence and clinical significance in an internal medicine department. Minerva Med. 1994, Apr; 85(4): 161-5
22．柳涛，王保法，郝咏梅，等．慢性阻塞性肺疾病与低T_3综合征，中华结核和呼吸杂志，2000，23(12)：741-742
23. Ursu HI, Peretianu D, Bulandra T, et al. Graves-Basedow's disease-asthma association. Presentation of five case. Rom J
Endocrinol, 1993,31:89-94
24． Van den Berghe G, de Zegher F, Lawers P. Dopamine and the sick euthyroid syndrome in critical illness. Clin Endocrinol (Oxf). 1994, 41:731-737
25． Spencer CA, Eigen A, Shen D, et al. Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients. Clin Chem. 1987,33:1391-1396．
26． Lee H-Y, Suhl J, Pedary AE, Hershman JM. Secretion of thyrotropin with reduced concanavalin-A-binding activity in patients with patients with severe nonthyroid illness. J Clin Endocrinol Metab. 1987, 65:942-945．
27． Huang TS, Wu HP, Huang LS, Lai MY, Ho SW, Chopra IJ. A study of thyroidal response to thyrotropin (TSH) in decompensated liver cirrhosis. Thyroidology. 1989,1: 137-142．
28． Brussel T, Matthay MA, Chernow B. Pulmonary manifestations of endocrine and metabolic disorders. Clin Chest Med. 1989 Dec; 10(4) : 645-53
29． Vasa FR, Molitch ME. Endocrine problems in the chronically critically ill patient. Clin Chest Med. 2001 Mar; 22(1) : 193-208
30． Cusro N, Scafidi V, Costanzo G, et al. Prospective study on thyroid
function anomalies in severely ill patients. Ann Ital Med Int. 1992 Jan-Mar; 7(1): 13-8
31．黄文庆，张孟贤．重危患者APACHEⅢ评分与甲状腺激素水平的关系．中国危重病急救医学．2002，14(5)：300-302
32．高绪文，李继莲主编．甲状腺疾病．第1版．北京：人民卫生出版社，1999，14-16
33. Brent GA, Hershman JM. Thyroxine therapy in patients with severe nonthyroidal illness and low serum thyroxine concertration. J Clin Endocrinol Metab, 1986, 63: 1-8
34. Ligtenberg JJ, Girbes AR, Beentjes JA, et al. Hormones in the critically ill patient: to intervene or not to intervene? Intensive Care Med 2001 Oct; 27(10): 1567-77
2．中华医学会呼吸病学会慢性阻塞性肺疾病学组．慢性阻塞性肺疾病诊治指南，中华结核和呼吸杂志，2002，25(8)：453-458
3．陈灏珠主编．实用内科学，第11版．北京：人民卫生出版社，2001，2553
4. Inder J. Chopra. Euthyroid sick syndrome: Is It a Misnomer? J Clin Endocrinol Metab. 1997, 82(2): 329-334
5. Di Napoli M, Reda G, Zannoni G, et al. The euthyroid sick symdrome. Its incidence and clinical significance in an internal medicine department. Minerva Med 1994 Apr; 85(4): 161-5
6．柳涛，王保法，王晓红，等．甘草对慢性阻塞性肺疾病患者糖皮质激素受体的影响．中华结核和呼吸杂志，1999，22：595-597
7. Reinhardt W, Mocker V, Jockenhovel F, et al. Influence of coronary bypass surgery on thyroid hormone parameter. Horm Res, 1997,47:1-8
8. Monig H, Arendt T, Meyer M, et al. Activation of the hypothalaamo-pituitary-adrenal axis in response to septic or non-septic diseases-implacations for the euthyroid sick syndrome. Intensive Care Med, 1999, 25: 1402-1406.
9. Boelen A, Mass MA, Lowik CW, et al. Induced illness in interleukin-6(IL-6)knock-out mice; a causal role of IL-6 in the
development of the low 3,5,3'-triiodothyroinine syndrome. Endocrinology, 1996, 137:5250-5254．
10． Chopra IJ, Huang TS, Beredo A, Solomon DH, Chua Teco GN. Serum thyroid hormone binding inhibitor in nonthyroid illnesses. Metabolism. 1986,35:152-159．
11． Chopra IJ, Chua Teco GN, Nguyen AH, Solomon DH. In search of an inhibitor of thyroid hormone binding to serum proteins in nonthyroid illnesses. J Clin Endocrinol Metab. 1979, 49:63-69．
12． Chopra IJ, Huang TS, Solomon DH, Chaudhary GN. The role of thyroxine (T4) -binding serum proteins in oleic acid induced increase in free T4 in nonthyroidal illness. J Clin Endocrinol Metab. 1986, 63:776-779．
13． Mendel C, Frost P, Cavalieri RR. Effect of free fatty acids on the concentration of free thyroxine in human serum: the role of albumin. J Clin Endocrinol Metab. 1986,63:1394-1399．
14． Gray-Donald K, Gibbons L, Shapiro SH, et al. Nutritional status and mortality in chronic obstructive pulmonary disease. Am J Respir Crit Care Med, 1996,153:961
15． 罗勇，徐卫国，姚迪，等．慢性阻塞性肺病营养状态与甲状腺激素相关性研究，上海医学, 2000, 23 (5) : 273-275
16. Siafakas NM, Milona I, Salesiotou V, et al. Respiratory muscle strength in hyperthyroidism before and after treatment. Am Rev Respir Dis, 1992, 146: 1025
17．吴斌，宋泽庆，李文．缺氧对慢性肺心病患者甲状腺功能的影响，中国实用内科杂志，2002，22(3)：156-158
18．方佩华，丁雅静，陈秉忠，等．各种生理、病理状态下血清甲状腺激素含量的变化——1140例测定结果分析[J]．中华核医学杂志，1983，3(4)：198-200．
19．张彦华，陈小妹．慢性肺心病病人的甲状腺激素变化．天津医药，1993，2，88-89
20. Wawrzynska L, Sakowicz A, Filipecki S. Euthyroid sick syndrome in patients with respiratory failure. Pneumonol Alergol Pol. 1996; 64 Suppl 2:193-9
21. Di Napoli M, Reda G, Zannoni G, et al. The euthyroid sick syndrome. Its incidence and clinical significance in an internal medicine department. Minerva Med. 1994, Apr; 85(4): 161-5
22．柳涛，王保法，郝咏梅，等．慢性阻塞性肺疾病与低T_3综合征，中华结核和呼吸杂志，2000，23(12)：741-742
23. Ursu HI, Peretianu D, Bulandra T, et al. Graves-Basedow's disease-asthma association. Presentation of five case. Rom J
Endocrinol, 1993,31:89-94
24． Van den Berghe G, de Zegher F, Lawers P. Dopamine and the sick euthyroid syndrome in critical illness. Clin Endocrinol (Oxf). 1994, 41:731-737
25． Spencer CA, Eigen A, Shen D, et al. Specificity of sensitive assays of thyrotropin (TSH) used to screen for thyroid disease in hospitalized patients. Clin Chem. 1987,33:1391-1396．
26． Lee H-Y, Suhl J, Pedary AE, Hershman JM. Secretion of thyrotropin with reduced concanavalin-A-binding activity in patients with patients with severe nonthyroid illness. J Clin Endocrinol Metab. 1987, 65:942-945．
27． Huang TS, Wu HP, Huang LS, Lai MY, Ho SW, Chopra IJ. A study of thyroidal response to thyrotropin (TSH) in decompensated liver cirrhosis. Thyroidology. 1989,1: 137-142．
28． Brussel T, Matthay MA, Chernow B. Pulmonary manifestations of endocrine and metabolic disorders. Clin Chest Med. 1989 Dec; 10(4) : 645-53
29． Vasa FR, Molitch ME. Endocrine problems in the chronically critically ill patient. Clin Chest Med. 2001 Mar; 22(1) : 193-208
30． Cusro N, Scafidi V, Costanzo G, et al. Prospective study on thyroid
function anomalies in severely ill patients. Ann Ital Med Int. 1992 Jan-Mar; 7(1): 13-8
31．黄文庆，张孟贤．重危患者APACHEⅢ评分与甲状腺激素水平的关系．中国危重病急救医学．2002，14(5)：300-302
32．高绪文，李继莲主编．甲状腺疾病．第1版．北京：人民卫生出版社，1999，14-16
33. Brent GA, Hershman JM. Thyroxine therapy in patients with severe nonthyroidal illness and low serum thyroxine concertration. J Clin Endocrinol Metab, 1986, 63: 1-8
34. Ligtenberg JJ, Girbes AR, Beentjes JA, et al. Hormones in the critically ill patient: to intervene or not to intervene? Intensive Care Med 2001 Oct; 27(10): 1567-77