| ObjectTo investigate the correlation between serum level of thyroid hormones,pulmonary function and syndrome characteristics of TCM in patients with COPD to explore the mechanism of serum level change of thyroid hormones in patients with COPD and how they influence their pulmonary function and syndrome characteristics of TCM in order to provide a new clue in diagnosing and treating patients with COPD by integration of TCM and western medicine.Methods1.Object1.1 AECOPD group 53 cases of COPD,diagnosed according to the COPD guideline published in 2013,were enrolled in the study.All of them were selected from the patients in first affiliated hospital of Guangzhou University of Traditional Chinese Medicine and they did not receive nutritional support or had other diseases that may influence organ metabolism nutritional status such as active tuberculosis,malignant tumor,hyperthyroidism,diabetes and Liver function or kidney functional disturbance and other wasting disease,and they are able to receive pulmonary function tests.1.2 Stable COPD group 40 cases,all from the AECOPD group,include those who get better after treatment and get into stable condition.1.3 Control group 30 healthy people were enrolled in study after the evaluation of history,physical inspection,auxiliary examination and without other systematic diseases or systemic infection in recent two months.2.Measure thyroid hormones in blood serum8ml vein blood was collected from all subjects in the morning and separated serum through centrifuge 15 minutes with a speed of 3500r/min,after standing for 30 minutes,we measured the level of TT3,TT4,FT3,FT4 and TSH by microsome chemiluminescence method.3.Pulmonary function testAll the subjects received pulmonary function test,the main indexes were as follows:FVC,FEV1%,FEV1/FVC%.4.Statistical analysisUse the SPSS 20.0 statistical analysis software for data analysis.The average of all the samples used t test,the comparison of rate use chi-square test,the relation of variables were calculated by linear correlation analysis or rank correlation analysis,a P value of<0.05 was considered statistically significant.Results1.The AECOPD group enrolled 53 cases,40 of them are male and 13 female,by an average age of 72 ± 7.4y,with the stable COPD group enrolled 40 cases,28 of them are male and 12 female,by an average age of 72.±7.7.And the control group enrolled 30,of 24 male and 6 female,by an average age of 71 ± 7.6y.All group of patients between the age and sex composition ratio was not statistical significance by using t test and chi-square test.2.The serum TT3,FT3,FT4 expression level of AECOPD group and control group was statistical significance(P<0.01),TT4,TSH was not statistical significance(P>0.05),and so is the stable COPD group and the control group.3.The average FEV1%of pulmonary function of stable COPD group is 43.95±13.97,and FVC%is 59.89±13.57.4.A analysis on AECOPD patients showed that phlegm heat obstructing lung syndrome(20 cases,37.7%of the COPD group)and turbid phlegm obstructing lung are the major two syndromes(33 cases,62.3%of the COPD group).On the other hand,the syndromes of stable COPD patients characterized as Qi deficiency,especially lung Qi deficiency(6 cases,11.3%),lung and spleen Qi deficiency(31 cases,58.5%)and lung and kidney Qi deficiency(16 cases,30.2%).5.There is negative correlation between TT3,FT3 and pulmonary function level in COPD patients,and close correlation between TSH,TT3 and FEV1%.No significant difference has been found between different syndromes of TCM in AECOPD patients,while in stable COPD patients,there are differences among different syndromes of TCM in thyroid hormones serum level.Patients with lung Qi deficiency syndrome had a higher serum level of TT3 than those who with lung spleen Qi deficiency syndrome or lung kidney Qi deficiency syndrome.No significant difference has been found on the pulmonary function level among different syndromes of TCM in all the COPD patients,while smoking index and course of COPD are closely related with pulmonary function level.Conclusion1.The serum level of TT3,FT3,FT4 in COPD patients is significantly lower than the control group,while TT4.TSH are not.2.The most important pathogenic factor is phlegm discriminated by TCM in AECOPD patients.And when it comes to stable COPD patients,deficiency of healthy atmosphere plays the most important role,characterized by the deficiency of lung Qi,spleen Qi and kidney Qi,especially the deficiency of lung and spleen Qi.To sum up in conclusion,the key factors in the progression of COPD are disharmony of the function of lung governing Qi and spleen governing fluid.Thus we can focus on adjusting the lung and spleen Qi,accompanied by reducing and clearing the phlegm pathogenic factor in treating COPD patients by TCM.3.There is correlation between the pulmonary function and the serum level of TT3 in COPD patients,showing that pulmonary function descending may has something to do with thyroid hormones abnormity,which makes it possible for them to complement each other in diagnosing,treating and predicting in COPD patients.4.The serum level of TT3 in those COPD patients discriminated as lung Qi deficiency is significantly higher than those discriminated as lung and spleen Qi deficiency or lung and kidney Qi deficiency,which reveals that the lower the serum TT3 is,the more Zang manifestations is damaged by TCM.That alert us to measure serum level of thyroid hormones in order to treat patients based on syndrome differentiation accurately by TCM. |
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