甲状腺激素联合APACHEⅡ评分在危重病患者近期预后评估中的应用价值

Value of thyroid hormone combined with APACHEⅡ score in evaluating short-term prognosis of patients with critically illness

目的探讨甲状腺激素联合急性生理学与慢性健康状况评价Ⅱ(APACHEⅡ)评分在危重病患者近期预后评估中的应用价值。方法 97例危重病患者完成甲状腺功能测定,根据出院时的治疗效果分为好转组(A组,75例)和未愈组(B组,22例),比较两组临床资料和实验室检查指标的差异。分析APACHEⅡ评分与甲状腺激素和实验室指标的相关性,探讨游离三碘甲状腺原氨酸(FT3)、APACHEⅡ评分以及两者联合应用在危重病患者近期预后评估中的应用价值。结果与B组相比,A组患者年龄小,住ICU时间和机械通气时间较短,APACHEⅡ评分和序贯器官衰竭评估评分降低,凝血酶原时间(PT)减少,FT3、三碘甲状腺原氨酸总量(TT3)、游离甲状腺素(FT4)、甲状腺素总量(TT4)和促甲状腺激素(TSH)水平增加(P<0.05)。APACHEⅡ评分与FT3、FT4和白蛋白水平呈负相关(rs=-0.389、-0.270和-0.210,P<0.05),与PT呈正相关(rs=0.210,P<0.05),而尚未发现与TSH和白细胞计数存在相关关系(rs=-0.164和0.077,P>0.05)。FT3[AUC=0.767,95%CI(0.662~0.872),P<0.05]、APACHEⅡ评分[AUC=0.660,95%CI(0.525~0.795),P<0.05]以及FT3联合APACHEⅡ评分[AUC=0.769,95%CI(0.665~0.873),P<0.05]均对危重病患者早期预后有较高的评估价值。结论危重病患者甲状腺激素水平越低,病情越重。FT3和APACHEⅡ评分联合应用可提高对危重病患者近期预后的评估价值。

Objective To explore the application value of thyroid hormones combined with acute physiology and chronic health evaluation Ⅱ(APACHEⅡ) score in evaluating the short-term prognosis of the patients with critically illness.Methods Thyroid hormones were examined in 97 patients with critically illness, of whom 75 cases were improved(group A) and 22 cases were unhealed(group B).The differences of clinical data and laboratory indexes were compared between the two groups.The relationship of APACHEⅡ score with thyroid hormones and laboratory indexes was analyzed.The value of FT3,APACHEⅡ score and in combination of them in evaluating the short-term prognosis of the patients with critically illness was investigated.Results Compared with group B,the age, ICU stay, mechanical ventilation time, APACHEⅡ score, sequential organ failure assessment score and prothrombin time(PT) were all significantly less, while the levels of FT3,TT3,FT4,TT4 and TSH were higher in group A(P<0.05).APACHEⅡ score was negatively correlated with the levels of FT3,FT4 and albumin(rs=-0.389,-0.270 and-0.210,P<0.05),positively correlated with PT(rs=0.210,P<0.05),but had no correlation with TSH and WBC count(rs=-0.164 and 0.077,P>0.05).The FT3 [AUC=0.767,95% CI(0.662-0.872),P<0.05],APACHEⅡ score [AUC=0.660,95% CI(0.525-0.795),P<0.05] and a combination of FT3 and APACHEⅡ score [AUC=0.769,95% CI(0.665-0.873),P<0.05] had higher value in evaluating the short-term prognosis of the patients with critical diseases.Conclusion The illness status is more severe in the critically illness patients with a lower thyroid hormones.Combined use of FT3 and APACHEⅡ score is able to improve the value in evaluating the short-term prognosis of the patients with critically illness.