Objective: To investigate the clinical features and prognosis of low triiodothyronine syndrome (LT3S) in patients with acute myeloid leukemia (AML) . Methods: A total of two 236 patients with AML who presented at the Jiangsu Provincial Hospital between January 2013 and December 2019 were included, and their data were retrospectively reviewed. The patients were divided into two groups, including the LT3S group and the non-LT3S group, according to their serum thyroxine level. The clinical characteristics and prognosis of the two groups were compared. Results: Among the 236 patients, 62 (26.3%) patients had LT3S. Serum-free T3 level was positively correlated with albumin (r=0.443, P<0.001) and hemoglobin (r=0.187, P=0.005) levels and negatively correlated with C-reactive protein (r=-0.406, P<0.001) and lactate dehydrogenase (r=-0.274, P<0.001) levels. The overall survival (OS) (7.5 months vs 29.9 months, P<0.001) and progression-free survival (PFS) (2.0 months vs 24.0 months, P<0.001) were significantly shortened in the LT3S group compared with the non-LT3S group. After propensity score matching, the OS (9.6 months vs 30.4 months, P=0.010) and PFS (3.0 months vs 30.0 months, P=0.014) were still significantly reduced in the LT3S group compared with the non-LT3S group. Therefore, LT3S was an independent risk factor for OS (HR=2.553, 95% CI 1.666-3.912, P<0.001) and PFS (HR=1.701, 95% CI 1.114-2.597, P=0.014) in patients with AML. Subgroup analysis suggested that patients with LT3S had a worse prognosis in patients with AML who were obese, fragile, or treated with standard chemotherapy. Conclusions: The occurrence of LT3S reflects the poor clinical status and prognosis of patients with AML.
目的： 探讨伴低T3综合征（LT3S）的急性髓系白血病（AML）患者的临床特征及预后。 方法： 回顾性分析2013年1月至2019年12月江苏省人民医院血液科连续收治的236例AML患者的临床资料，按照血清甲状腺素水平将其分为LT3S组和非LT3S组，比较两组患者的临床特征及预后。 结果： 在236例AML患者中，有62例（26.3%）患者出现LT3S。血清游离三碘甲状腺原氨酸（T3）水平与白蛋白（r=0.443，P<0.001）、血红蛋白（r=0.187，P=0.005）水平呈正相关，与C反应蛋白（r=-0.406，P<0.001）、乳酸脱氢酶（r=-0.274, P<0.001）水平呈负相关。LT3S组与非LT3S组相比，总生存（OS）期（7.5个月对29.9个月，P<0.001）和无进展生存（PFS）期（2.0个月对24.0个月，P<0.001）明显缩短。使用倾向性匹配评分均衡患者基线资料后显示，LT3S组与非LT3S组相比OS期（9.6个月对30.4个月，P=0.010）和PFS期（3.0个月对30.0个月，P=0.014）仍明显缩短。合并LT3S是影响AML患者OS（HR=2.553，95% CI 1.666~3.912，P<0.001）和PFS（HR=1.701，95% CI 1.114~2.597，P=0.014）的独立危险因素。亚组分析提示，在肥胖、体能状态差或采用标准方案化疗的AML亚组中合并LT3S者预后更差。 结论： LT3S的发生反映AML患者临床状态差，不能耐受高强度化疗，预后不良。.
Keywords: Clinical status; Leukemia, myeloid, acute; Low T3 syndrome; Prognosis.