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https://doi.org/10.14300/mnnc.2024.19046

Systemic inflammation in patients with community-acquired pneumonia combined with subclinical hypothyroidism

[Internal diseases]
Natalia Vasilyevna Chayka; Galina Pavlovna Pobedyonnaya; Alexey Sergeevich Bisov; Yulia Ivanovna Vagina;

In the study was investigation the factors of systemic inflammation in patients with community-acquired pneumonia combined with subclinical hypothyroidism (SH). One hundred thirty four people aged 37.4±3.3 years were observed, including 32 with CAP combined with SH (the main group), 68 with CAP without SH (the comparison group) and 34 healthy individuals. In all patients with CAP, along with the generally accepted laboratory and instrumental examinations for CAP and SH, the concentration of C-reactive protein (CRP), ferritin, nitric oxide metabolites, morphofunctional characteristics of erythrocytes, «medium molecules», malondialdehyde (MDA) and diene conjugates (DC), catalase and superoxide dismutase (SOD) activity were determined. Along with the clinical signs of CAP, non-manifest clinical signs of SH were detected in patients of the main group. In patients of the main group, systemic inflammation of high activity was revealed with a significant increase in the concentration of CRP and ferritin from those in the comparison group, and its secondary messengers: an increase in the concentration of nitric oxide metabolites, endogenous metabolic intoxication syndrome with an increase in the sorption capacity of erythrocyte membranes, an increase in «medium molecules» in the blood of patients. The high activity of systemic inflammation was supported by oxidative stress with 1.3-fold increased levels of MDA and DC in patients of the main group compared with the comparison group and an insufficient increase in catalase and SOD activity, which was facilitated by SH, according to the revealed correlations between the studied indicators and TSH levels. Intense systemic inflammation, oxidative stress and signs of endogenous metabolic intoxication in patients with CAP in combination with SH contribute to the syndrome of aggravation of the course of CAP with longer resorption of the pneumonic infiltrate in the average time of inpatient treatment in 41 % of cases versus 23 % in the comparison group and incomplete clinical and laboratory recovery, which should be taken into account in the timely diagnosis of SH, personalized treatment and further follow-up of patients with such comorbidity.

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Keywords: community-acquired pneumonia, subclinical hypothyroidism, systemic inflammation, oxidative stress, endogenous metabolic intoxication syndrome