新冠肺炎患者的内分泌功能障碍:来自孟加拉国三级医院的经验

S. M. Arafat, Hurjahan Banu, Md Shahed Morshed, N. Sultana, A. Saleh, M. Hasanat
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摘要

背景:2019冠状病毒病(COVID-19)易对内分泌系统造成破坏和功能障碍。关于恢复后激素随访状态的数据在文献中很少。该研究的目的是评估COVID-19非危重患者在急性感染期间和感染后三个月内的激素水平和状态。方法:本纵向研究于2021年9月至2022年2月在一家三级保健医院对91名非关键rt - pcr确诊的COVID-19患者进行。在了解相关病史并进行体格检查后,于住院期间和三个月后的早上07:00 - 09:00间空腹抽血,测定血清TSH、FT4、总睾酮(TT)、DHEAS、皮质醇和血浆ACTH。化学发光微粒免疫法测定各组激素水平。结果:入院时,19.8%的受试者存在肾上腺功能不全(<276 nmol/L), 28.0%存在不同类型的甲状腺功能异常。37名男性中,8.1% TT低,29.7% DHEAS低。54名女性中,高TT者占27.8%,低DHEAS者占7.4%,高DHEAS者占3.7%。其中91.8人死亡,68人没有随访,只有15人的随访激素水平可查。肾上腺功能不全的参与者从1人增加到7人。入院时出现不同类型甲状腺功能异常7例,其中原发性甲状腺功能减退2例,减少至3例。男性TT和DHEAS状态恶化,而女性高雄激素血症状态增加。结论:即使在非危重病例中,短期随访期间肾上腺功能不全也很常见,而甲状腺功能异常的患者大多康复。在雄激素状态下观察到性别特异性的相反反应。中华医学杂志2023;第34卷,第2(1)号补编:218
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Endocrine Dysfunc-Tion Among Patients with Covid-19: A Experience from Tertiary Hospital in Bangladesh
Background: Endocrine systems are vulnerable to destruction and dysfunction by coronavirus disease 2019 (COVID-19). Data regarding the follow-up status of hormones following the recovery are scarce in the literature. The aim of the study to evaluate hormone levels and statuses among noncritically ill patients with COVID-19 during and three months after acute infection. Methods: This longitudinal study was done in a tertiary care hospital from September 2021 to February 2022 among 91 noncritical RT-PCR-confirmed COVID-19 patients. After taking relevant history and performing physical examinations, blood was drawn between 07:00 am to 09:00 am in a fasting state to measure serum TSH, FT4, total testosterone (TT), DHEAS, cortisol, and plasma ACTH during hospitalization and after three months. All the hormones were measured by chemiluminescent microparticle immune assay. Results: During admission,19.8% of participants had adrenal insufficiency (<276 nmol/L) and 28.0% had different types of thyroid function abnormalities. Among 37 males, 8.1% had low TT and 29.7% had low DHEAS. Among 54 females, 27.8% had high TT and 7.4% had low and 3.7% had high DHEAS. Among 91, 8 died, 68 were lost to follow-up, and follow-up hormone levels were available for only 15 participants. The number of participants with adrenal insufficiency increased from 1 to 7. During admission, 7 patients had various types of thyroid function abnormalities which reduced to only three cases including two cases of primary hypothyroidism. While TT and DHEAS status deteriorated in males, increased hyperandrogenemia status was observed in females. Conclusion: Adrenal insufficiency is common during shortterm follow-up periods even in noncritical cases of COVID-19 whereas most of the patients with thyroid function abnormalities recovered. A sex-specific opposite response was observed in androgen status. J Medicine 2023; Vol. 34, No. 2(1) Supplement: 218
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