左甲状腺素钠治疗重症肺结核伴正常甲状腺病态综合征临床分析

目的 探讨对重症肺结核伴正常甲状腺病态综合征（euthyroid sick syndrome,ESS）的患者应用小剂量左甲状腺素钠治疗的有效性.方法 将120例重症肺结核伴ESS住院患者按性别、年龄、病程、疾病严重程度随机分为治疗组和对照组.治疗组在常规抗结核及控制感染、营养对症支持治疗的基础上加服小剂量左甲状腺素钠（12.5μg/d）,对照组按常规治疗,治疗时间均为2周.比较两组甲状腺功能、临床症状改善、白蛋白升高、痰涂片抗酸杆菌减少、影像学改善情况及病死率.结果 治疗2周后,两组患者发热、咳嗽、盗汗等症状有不同程度好转,其中治疗组中显效者19例（31.7%）,对照组中显效者8例（13.3%）,两组比较差异有统计学意义（χ2=5.73,P＜0.05）.治疗组痰菌转阴15例（25.0%）,对照组4例（6.7%）,两组比较差异有统计学意义（χ2=7.50,P＜0.01）.治疗组患者治疗后血清白蛋白升高至（34.2±0.4）g/L,明显高于对照组的（29.1±0.6）g/L,经比较两组的差异具有统计学意义（t=2.42,P＜0.05）.两组患者的T3、FT3在治疗后均明显上升,但治疗组升高尤为显著,两组治疗前后差值比较差异有统计学意义（t值分别为59.42和50.66,P值均＜0.01）.治疗组与对照组均未见空洞闭合,但有部分患者的结核病灶出现吸收好转,其中治疗组治疗有效56例（93.3%）,对照组治疗有效46例（76.7%）,两组比较差异有统计学意义（χ2=6.54,P＜0.05）.治疗组未出现死亡病例,对照组病死率为3.3%（2/60）.结论 对重症肺结核伴ESS的患者在常规治疗的前提下,再辅以小剂量左甲状腺素钠治疗安全有效,低T3的改善是整个病情好转的重要指标.

Levothyroxine sodium in treatment of severe pulmonary tuberculosis with euthyroid sick syndrome

Objective To evaluate the efficacy of low-dose levothyroxine sodium in treatment of severe pulmonary tuberculosis with euthyroid sick syndrome（ESS）. Methods One hundred and twenty inpatients with severe pulmonary tuberculosis and ESS were randomly divided into treatment group and control group by gender, age, disease duration and severity. Both groups were given anti- tuberculosis, antiinfection treatment and nutritional support for 2 weeks; patients in treatment group were given low-dose levothyroxine sodium additionally. Thyroid function, clinical improvements, increase of albumin, reduction of acid-fast bacilli, improvements on images and the mortality rates were compared between the groups.Results After 2 weeks of treatment, symptoms including fever, cough and night sweats were improved in both groups. Marked improvements were observed in 19 patients（31.7%）of treatment group and 8 patients （13.3%）of control group（χ2 = 5. 73, P 〈 0.05）. Clearance rate of acid-fast bacilli in treatment group was 25.0%（15/60）, but that in the control was only 6.7%（4/60）（χ2 = 7. 50, P 〈 0.01）. Serum albumin in the treatment group was increased to（34.2 ±0.4）g/L after the treatment, and that in the control group was（29.1 ±0.6）g/L（t =2.42, P〈0.05）. T3 and FT3 were significantly increased in both groups, but more significant difference was observed in the treatment group（t = 59. 42 and 50. 66, P 〈 0. 01）. No empty closed after treatment in both groups, but the effective rate in treatment group was significantly higher than that in the control group（93.3% vs. 76.7%, χ2 =6. 54, P〈0.05）. Two patients in control group died（2/60, 3. 3%）, while no death was reported in treatment group. Conclusions Low-dose levothyroxine sodium treatment is effective for ESS in patients with severe pulmonary tuberculosis.Improvement on low T3 syndrome may be an important indicator for the overall improvement or recovery.