| Part One The clinical characteristics of thyroid function and NTIS in elderly male inpatientsObjective: To understand the clinical characteristics of thyroid function and NTIS in the elderly male inpatients （aged over 60 years）. Methods: Using cross sectional study, a survey was carried out among 931 male subjects aged 60 or over who was hospitalized during January 2012 and December 2013. All patients were divided into NTIS group and control group according to whether the patient was with NTIS.Projects of survey include TT4、TT3、FT3、FT4、TSH and chronic diseases which may affect life. All data were reviewed by cases or telephone follow-up of patients or family members. Measurements obeying normal distribution were expressed as mean±standard deviation （x±s）. t-test or t’-test was used for intergroup comparisons,and counts were analyzed by x2 test or Fisher’s test. Results: （1） There were total 931 patients in our study and 24 were lost to follow-up, with a follow-up rate of 97.42%.The level of TT4, TT3 and FT3 decreased with age while the abnormal rate of TT3 and the prevalence of NTIS increased with age. （2） There were 193 people in the NTIS group and 738 in the control group. The prevalence of NTIS was 26.2% and the age of this group was higher than that of the control group, while the level of TT4, TT3,FT3 were lower than the control group （P<0.001） . The most common diseases in both groups were respiratory and cardiovascular system diseases. NTIS group were 90.7% and 56.9%,while the other group was 88.5% and 24.1%. Comparing with control group, the incidence of respiratory diseases（P <0.001 ）,CKD（P <0.001） and tumor （P=0.020） was higher in NTIS group. Conclusion: The level of TT4, TT3 and FT3 decreased with age while the abnormal rate of TT3 increased with age. The prevalence of NTIS and TSH increased with age. The incidence of respiratory system diseases,CKD and tumor were higher in the NTIS group.Part Two The clinical characteristics of NTIS and 2 years survival in elderly male inpatientsObjective: To understand the prevalence of NTIS in the elderly male population（aged over 60 years）, the relationship between FT3, TT3 and nutritional status, liver and kidney function, chronic diseases and the effects of FT3 and TT3 on mortality.Methods: Using cross sectional study, a survey was carried out among 931 male subjects aged 60 or over who was hospitalized during January 2012 and December 2013. All patients were divided into NTIS and control group according to whether the patient was with NTIS. Projects of survey include TT4,TT3,FT3,FT4,TSH,TP,Alb,PA,Ur,Cr, UA,ALT,AST,Hb and chronic diseases which may affect life. All data was reviewed by cases or telephone follow-up of patients or family members.Measurements obeying normal distribution were expressed as mean±standard deviation （x ± s）. t-test or t’-test was used for intergroup comparisons, and one-way ANOVA was employed to the means among multiple groups. Counts were analyzed by x2 test or Fisher’s test. Coexistence of lower T3 levels with concurrent chronic diseases was analyzed using correspondence analysis model. All tests were two-sided.Kaplan-Meier analysis was used to generate survival-time data, and difference in the survival between the two groups was analyzed using Lo-rank test. Results: （1）The level of TP, ALb, PA, Hb, BMI in the NTIS group were lower than those in the control group. Pearson correlation analysis shows there were positive correlations between TP （r=0.137, P<0.001） ,ALb （r=0.410, P<0.001） ,PA （r=0.244, P<0.001）,Hb （r=0.386,P<0001）,BMI (r=0.443,P<0.001 and TT3 and TP （r=0.125,P<0.001）,ALb （r=0.470,P<0.001）,PA （r=0.285, P<0.001）,Hb （r=0.384,P<0.001 ）,BMI（r=0.456, P<0.001 ）and FT3. （2） Pearson correlation analysis shows there were negative correlations between AST （r＝-0.111, P<0.05） and TT3. （3） The level of urea （P< 0.001） and creatinine （P<0.001） in NTIS group were higher than those in control group while Uric acid was lower （P=0.008） . Pearson correlation analysis shows there were negative correlations between Urea （r=-0.310, P < 0.001）,creatinine （r=-0.193,P<0.001） and FT3. There were negative correlations between Urea （r=-0.241,P<0.0001 ）creatinine （r=-0.173,P<0.001） and TT3. （4）The corresponding analysis model showed that the FT3 and TT3 reduction usually coexist with CKD.（5）There were total 169 patients died with a mortality rate of 18.2%, 69 in the NTIS group of 35.8% and 100 in the control group of 13.5%. The survival rate of the two groups decreased gradually with the prolongation of observation time. The cumulative survival rate of the NTIS group was significantly lower than that of the control group （Log-rank x2=60.332, P<0.001）. （6）Multi variate Cox model analysis showed that lower TT3 （HR=0.534, 95% CI=0.405-0.705,P<0.001） is a risk factor for death after adjusting for age.Conclusion: The nutritional status and renal function in the NTIS group were lower. The probability of lower levels of FT3 and TT3 always coexisted with CKD. The mortality rate of NTIS group was higher than that of control group. After adjusting for age, lower TT3 level increased mortality.Part Three The clinical characteristics of NTIS and 2 years survival in elderly male with pulmonary infection inpatientsObjective: To understand the prevalence of NTIS in the elderly male population（aged over 60 years） hospitalised for pulmonary infection, the relationship between FT3,TT3 and inflammation index ,chronic diseases and the effects of FT3 and TT3 on mortality. Methods: Using cross sectional study, a survey was carried out among 239 male subjects aged 60 or over who were hospitalized during January 2012 and December 2013. All patients were divided into NTIS group and control group according to whether the patient was with NTIS. Projects of survey include temperature,blood oxygen saturation,PaO2,TT4,TT3,FT3,FT4,TSH,WBC,neutrophil percentage ,CRP and chronic diseases which may affect life. All data was reviewed by cases or telephone follow-up of patients or family members. Measurements obeying normal distribution were expressed as mean±standard deviation （x ± s）. T-test or t’-test was used for intergroup comparisons, and one-way ANOVA was employed to the means among multiple groups. Counts were analyzed by x2 test or Fisher’s test.Coexistence of lower T3 levels with concurrent chronic diseases was analyzed using correspondence analysis model. All tests were two-sided. Kaplan-Meier analysis was used to generate survival-time data, and difference in the survival between the two groups was analyzed using Log-rank test. Results: （1） There were total 239 patients in our study, 74 people in the NTIS group and 165 in the control group. There were 24 patients were lost to follow-up, with a follow-up rate of 96.65%. （2） The level of TT4, TT3, FT3 of NTIS group was lower than that of control group （P <0.001） . The most common diseases in both groups were cardiovascular system diseases. The percentage of NTIS group was 89.2%,while the control group 92.1%. Comparing with control group, the incidence of CKD and COPD history was higher in NTIS group.The proportion of using ventilator in NTIS group was higher than that in control group（P<0.001）.（3） The level of WBC（P=0.008）,neutrophil proportion（P=0.015）,CRP（P=0.002）, use time of antibiotic（P <0.001 ）in the NTIS group were higher than those of the control group. Pearson correlation analysis shows there were negative correlations between CRP （r=-0.258,P<0.001） 、WBC （r=-0.207,P=0.003）、neutrophil proportion（r=-0.184,P=0.004）、use time of antibiotic （r=-0.196,P=0.002）and TT3 and CRP （r=-0.264, P<0.001）、WBC （r=-0.199, P=0.002） and FT3. The corresponding analysis model showed that the TT3 reduction usually coexist with COPD. （4）At the end of the follow-up period,59 subjects were died of various diseases, with a mortality rate of 24.69% and Survival rate of 71.97%.There were total 25 patients in the NTIS group died with a mortality rate of 33.8%, and 34 in the control group with of 20.6%. The survival rate of the two groups decreased gradually with the prolongation of observation time. The cumulative survival rate of the low T3 syndrome group was significantly lower than that of the control group （log-rank x2=60.332, P=0.007） . （5）Multivariate Cox model analysis showed that the overall population mortality decreased with the increase of FT3 and TT3 levels after adjusting for age.Conclusion: Comparing with the control group, the number of WBC,neutrophils, CRP was higher in patients with NTIS, and the use time of antibiotics was longer. The probability of lower levels of T3 always coexisted with COPD. |
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