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。

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. TT₃ was 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.