目的 探索ICU脓毒血症患者甲状腺激素水平动态变化与患者预后的关系。方法 选择2015-01至2017-08医院ICU收住的脓毒血症患者172例作为病例组,根据APACHEⅡ评分进一步分为轻度脓毒血症组(72例)、严重脓毒血症组(62例)、脓毒血症休克患者(38例),同时选取普通病房的患者73例作为对照组;病例组中患者入ICU 28 d后根据生存情况分为生存组和死亡组;在不同时间点对患者甲状腺激素水平进行监测,甲状腺激素水平与不同预后结局和APACHEⅡ评分相关性进行研究。结果 入院24 h、4 d、10 d病例组的T3、T4、FT3、FT4、TSH水平都显著低于对照组(P<0.05),T3、T4、FT3、FT4、TSH的水平在病例组中呈现出脓毒血症休克组<严重危重组<危重组的变化趋势,随着入住ICU时间的延长,病例组中T3、T4、FT3、FT4、TSH水平呈现增高的趋势,但都显著低于对照组;死亡组T3、T4、FT3、FT4、TSH水平低于生存组,相关性分析表明APACHEⅡ评分与T3、T4、FT3、FT4、TSH水平呈现负相关性(P<0.05),与PCT和CRP水平呈现正相关性(P<0.05)。结论 ICU脓毒血症患者甲状腺激素水平明显降低,其下降程度与危重程度有关,监测甲状腺激素水平有助于临床治疗和改善患者预后。
Abstract
Objective To explore the relationships between dynamic changes of thyroid hormone levels and prognosis in patients with ICU sepsis.Methods A total of 172 patients with sepsis diagnosed according to the diagnostic criteria of the ICU and admitted to our hospital between January 2015 and August 2017 were selected as the subjects (the case group). According to the APACHE Ⅱ score, these patients were divided into the sepsis group (72 cases), severe sepsis group (62 cases), and septic shock patients (38 cases), while another 73 patients from ordinary wards were selected as the control group. The case group was again divided into the survival group and death group according to the patients’ survival 28 days after admission to the ICU. The thyroid gland was treated at different time points. Hormone levels were monitored and correlations of thyroid hormone levels with different prognostic outcomes and APACHE Ⅱ scores were studied.Results The levels of T3, T4, FT3, FT4, and TSH in the 24 h, 4 d, and 10 d cases were significantly lower than those in the control group (P<0.05). These levels in the septic shock group were significantly higher than those in the control group. They increased with the prolongation of ICU stay in the case group, and were significantly lower in the death group than in the survival group. Correlation analysis showed that the APACHE Ⅱ score was negatively correlated with T3, T4, FT3, FT4 and TSH levels (P<0.05), while PCT and CRP levels showed a positive correlation (P<0.05).Conclusion The level of thyroid hormone in patients with ICU sepsis is significantly reduced, depending on the severity of the disease. Monitoring thyroid hormone levels can help clinical treatment and improve prognosis of patients.
关键词
脓毒血症 /
甲状腺激素 /
重症监护病房 /
预后
Key words
sepsis /
thyroid hormone /
ICU /
prognosis
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