危重慢性阻塞性肺疾病血清甲状腺激素水平低下患者的干预研究

目的探讨对危重慢性阻塞性肺疾病血清甲状腺激素水平低下患者采用甲状腺激素替代治疗的干预效果。方法选取2008年7月至2011年6月慢性阻塞性肺疾病急性加重（AECOPD）合并呼吸衰竭和/或心力衰竭且血清甲状腺激素水平低下的住院患者67例,随机分为治疗组（34例）和对照组（33例）。治疗组在与对照组相同常规治疗基础上加用甲状腺激素替代治疗。结果治疗组与对照组患者总有效率无显著差异（88.2%比81.8%,P〉0.05）,但治疗组的显效时间明显短于对照组[（9.6±2.5）d比（12.3±2.8）d,P〈0.05]。治疗组治疗后血清FT3、FT4、TT4、h-TSH水平明显高于对照组（P〈0.05）,治疗组治疗后血清FT3、TT3、FT4、TT4、h-TSH水平明显高于治疗前（P〈0.05）。结论对肺功能重度、极重度损害的AECOPD合并心力衰竭和/或呼吸衰竭且血清甲状腺激素水平低下的患者,在保证营养供给的情况下补充少量甲状腺激素将有助于提高患者血清甲状腺激素水平,促进患者及早恢复。

Effects of Thyroid Hormone Replacement Therapy on Critically Ill COPD Patients with Decreased Serum Thyroid Hormone

Objective To investigate the therapeutic effects of thyroid hormone replacement on critically ill COPD patients with low serum thyroid hormone.Methods Sixty-seven critically ill patients with acute exacerbation of COPD(AECOPD),and complicated with respiratory and/or heart failure and low serum thyroid hormone,admitted from July 2008 to June 2011,were recruited for the study.They were randomly divided into an intervention group(n=34) and a control group(n=33).The control group received conventional treatment and the intervention group received conventional treatment plus additional thyroid hormone replacement therapy.Results Compared with the control group,the overall efficacy of the intervention group was not significantly different(88.2% vs.81.8%,P>0.05),while average effective time was significantly shorter [(9.6±2.5)d vs.(12.3±2.8)d,P<0.05].The post-treatment serum FT3,FT4,TT4,and h-TSH levels were significantly higher in the intervention group than those in the control group,and significantly higher than baseline(P<0.05).Conclusions For AECOPD patients complicated with respiratory and/or heart failure and low serum thyroid hormone,thyroid hormone supplement at low dosage will help to improve serum thyroid hormone level,and promote early recovery.