甲状腺激素水平对社区获得性肺炎预后的影响

doi:10.16138/j.1673-6087.2021.05.012

摘要/Abstract

摘要：

目的：探讨甲状腺激素水平对社区获得性肺炎（community acquired pneumonia, CAP）患者病情预后的影响。方法：纳入2018年1月至2020年10月入住上海交通大学医学院附属新华医院急诊科的343例CAP患者,采集患者的性别、年龄、基础疾病等一般资料,入院时的甲状腺激素水平[总3,5,3’-三碘甲腺原氨酸（total 3,5,3’triiodothyronine, TT₃）、总甲状腺素（total thyroxine, TT₄）、游离T₃（free T₃,FT₃）、游离T₄（free T₄, FT₄）、促甲状腺激素（thyroid stimulating hormone,TSH）、反式T₃（reverse T₃,rT₃）]和血清白蛋白、白细胞（white blood cell, WBC）、降钙素原（procalcitonin, PCT）、C反应蛋白（C-reactive protein,CRP）、D-二聚体、肺炎严重指数（pneumonia severity index,PSI）评分和CURB-65评分等临床资料。根据预后情况分为生存组（321例）和死亡组（22例）。分析以上因素与预后的相关性。结果：死亡组TT₃、TT₄、rT₃、TSH及血清白蛋白水平均低于存活组（P均<0.05）,D-二聚体水平、PSI评分和CURB-65评分高于生存组（均P≤0.001）,而2组间的FT₃、FT₄、PCT、CRP、WBC水平差异无统计学意义。与生存组相比,死亡组平均年龄较高[（80.55±7.80）岁比（73.66±13.57）岁,P=0.019]。单因素Logistic回归分析显示, T₃（β=-3.389）对CAP病死率的预测能力高于血清白蛋白（β=-0.213）、D-二聚体（β=0.909）、PSI评分（β=0.027）和CURB-65评分（β=0.597）。多因素二元Logistic回归分析显示,在甲状腺激素指标中,TT₃与CAP患者病死率独立相关,且与PSI评分（r=-0.489,P<0.001）、CURB-65评分（r=-0.474,P<0.001）、年龄（r=-0.344,P<0.001）、D-二聚体（r=-0.374,P<0.001）呈负相关,与白蛋白（r=0.353,P<0.001）呈正相关。结论：甲状腺激素水平、年龄、血清白蛋白、D-二聚体以及PSI评分、CURB-65评分与CAP的预后相关。TT₃是CAP预后的独立预测因子,TT₃联合PSI评分及CURB-65评分会提高预测CAP预后的能力。

关键词: 甲状腺激素, 社区获得性肺炎, 预后

Abstract:

Objective To evaluate the influence of thyroid hormone levels on prognosis of the patients with community-acquired pneumonia(CAP). Methods A total of 343 CAP patients admitted to the Emergency Department of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2018 to October 2020 were enrolled in this study. The clinical data of patients, including gender, age, basic diseases, thyroid hormone levels [total 3, 5, 3’triiodothyronine (TT₃), total thyroxine (TT₄), free T₃ (FT₃), free T₄ (FT₄), thyroid stimulating hormone (TSH), reverse T₃ (rT₃)] and serum albumin, white blood cell (WBC）, procalcitonin (PCT), C-reactive protein (CRP), D-dimer, pneumonia severity index (PSI) scores and CURB-65 scores were collected. According to the prognosis, they were divided into survival group (n=321) and death group(n=22). The relation between the factors mentioned above and prognosis was analyzed. Results The levels of TT₃, TT₄, rT₃, TSH and serum albumin in the death group were lower than those in the survival group (all P<0.05), while the levels of D-dimer, PSI scores and CURB-65 scores in the death group were higher than those in the survival group (all P<0.001). There was no significant difference in the levels of FT₃, FT₄, PCT, CRP and WBC between two groups (all P>0.05). The average age of death group was higher than that of survival group (80.55±7.80 vs 73.66±13.57, P=0.019). Univariate Logistic regression analysis showed that TT₃ ( β=-3.389) was the best predictor of CAP mortality, which was higher than serum albumin level ( β=-0.213), D-dimer ( β=0.909), PSI scores ( β=0.027) and CURB-65 scores (β=0.597). Multivariate logistic regression analysis showed that TT₃ was independently associated with mortality in patients with CAP, and negatively correlated with PSI scores (r=-0.489, P<0.001), CURB-65 scores (r=-0.474, P<0.001), age (r=-0.344, P<0.001), D-dimer (r=-0.374, P<0.001), and positively correlated with albumin (r=0.353, P<0.001). Conclusions Thyroid hormone levels, age, serum albumin, D-dimer, PSI scores and CURB-65 scores were related to the prognosis of CAP. TT₃was an independent predictor of the prognosis of CAP among all thyroid hormone indicators, and TT₃ combined with PSI scores, or CURB-65 scores can improve the efficacy to predict CAP outcome.

Key words: Thyroid hormone, Community-acquired pneumonia, Prognosis

中图分类号:

R563.1

李聪, 王永辉, 高磊, 高晶晶, 包鹏, 高艳虹. 甲状腺激素水平对社区获得性肺炎预后的影响[J]. 内科理论与实践, 2021, 16(05): 349-353.

LI Cong, WANG Yonghui, GAO Lei, GAO Jingjing, BAO Peng, GAO Yanhong. Influence of thyroid hormone levels on prognosis of community-acquired pneumonia[J]. Journal of Internal Medicine Concepts & Practice, 2021, 16(05): 349-353.

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参考文献 19

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项目	生存组（n=321）	死亡组（n=22）	P
年龄（岁）	73.66±13.57	80.55±7.80	0.019
基础疾病[n（%）]
高血压	193（60.1）	12（45.5）	0.606
糖尿病	88（27.4）	11（50.0）	0.024
冠心病	99（30.8）	9（40.9）	0.342
慢性肝病	12（3.7）	1（4.5）	0.584
慢性肾病	36（11.2）	4（18.2）	0.521
脑血管疾病	62（19.3）	5（22.7）	0.910
慢性支气管炎	91（28.3）	4（18.2）	0.460
慢性阻塞性肺疾病	63（19.6）	2（9.1）	0.275
恶性肿瘤	17（5.3）	3（13.6）	0.128
胸腔积液[n（%）]	105（32.7）	11（50.0）	0.097

变量	β	OR	95%置信区间	P
TT₃	-3.389	0.034	0.007~0.161	<0.001
FT₃	-0.348	0.706	0.426~1.169	0.176
lnrT₃	-1.284	0.277	0.134~0.574	0.001
lnTT₄	-2.002	0.135	0.029~0.632	0.011
lnFT₄	0.927	2.528	0.761~8.394	0.130
lnTSH	-0.589	0.555	0.364~0.845	0.006
lnD-二聚体	0.909	2.481	1.681~3.662	<0.001
白蛋白	-0.213	0.808	0.725~0.901	<0.001
PSI评分	0.027	1.027	1.014~1.040	<0.001
CURB-65评分	0.597	1.817	1.250~2.641	0.002

项目	生存组（n=321）	死亡组（n=22）	P
PCT(μg/L)	0.19（0.10,0.74）	0.33(0.14,1.50)	0.069
CRP(mg/L)	55（16.00,126.00）	74(27.25,160.00)	0.201
WBC(10⁹)	9.26±4.77	11.02±6.38	0.102
血红蛋白(g/L)	118.19±22.64	114.45±19.57	0.452
白蛋白(g/L)	34.55±5.78	29.94±4.77	<0.001
D-二聚体(mg/L)	0.46（0.26,0.81）	1.22(0.49,5.99)	0.001
TT₃(nmol/L)	1.09±0.38	0.712±0.28	<0.001
FT₃(pmol/L)	3.34±1.53	2.94±2.64	0.275
TT₄(nmol/L)	95.80(79.05,114.55）	87.95(58.63,103.63)	0.037
FT₄(pmol/L)	16(14.10,18.13)	15.49(13.83,18.04)	0.704
rT₃(μg/L)	0.45(0.37,0.55)	0.34(0.24,0.41)	<0.001
TSH(mU/L)	1.12(0.60,2.00)	0.81(0.31,1.40)	0.014

项目	生存组（n=321）	死亡组（n=22）	P
PSI评分（分）	99.52±34.98	135.36±30.93	<0.001
Ⅰ~Ⅲ级[n(%)]	258（80.4）	10（45.5）
Ⅳ或Ⅴ级[n(%)]	63（19.6）	12（54.5）	<0.001
CURB-65评分（分）	1.56±1.05	2.32±1.04	0.001
0~2[n(%)]	267（83.2）	13（59.1）
≥3[n(%)]	54（16.8）	9（40.9）	0.005

项目	AUC	95%置信区间	截断值	灵敏度	特异度	Youden指数
D-二聚体	0.711	0.582~0.841	1.655	0.500	0.882	0.382
白蛋白	0.762	0.656~0.868	32.050	0.818	0.648	0.466
TT₃	0.799	0,708~0.890	0.775	0.727	0.798	0.525
FT₃	0.773	0.661~0.886	2.755	0.818	0.695	0.513
TT₄	0.633	0.505~0.760	66.650	0.364	0.897	0.261
FT₄	0.524	0.398~0.651	15.805	0.591	0.520	0.111
rT₃	0.739	0.640~0.837	0.435	0.864	0.545	0.409
TSH	0.656	0.536~0.776	1.015	0.727	0.542	0.269
PSI评分	0.786	0.713~0.860	107.5	0.909	0.614	0.523
CURB-65评分	0.704	0.596~0.812	1.500	0.818	0.539	0.357