重症SIRS患者的正常甲状腺病态综合征

The euthyroid sick syndrome in severe SIRS patients

目的:探索全身炎症反应综合征(SIRS)患者的正常甲状腺病态综合征(ESS)的发生规律。方法:测定50例SIRS病人的总三碘甲状腺原氨酸(TT3)、总四碘甲状腺原氨酸(TT4)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、促甲状腺素(TSH),并根据是否多脏器功能障碍综合征(MODS)分组。计算急性生理和慢性健康评估Ⅱ(APACHEⅡ)评分,记录病人转归以及从发病到检测的时间(患病时间)。结果:TT3或FT3降低的45例。TT3与APACHEⅡ评分呈对数负相关(r=-0·330,P<0·05),TT3/TT4与患病时间呈对数负相关(r=-0·316,P<0·05)。MODS组的TT3、TT4、FT3水平显著低于无MODS组(P<0·05)。结论:SIRS和MODS病人发生低T3、低T4可能性大,反映炎症反应对甲状腺轴的影响,随着病情加重、患病时间延长,影响进一步深化。

AIM： To assay the pattern of thyroid hormone alternations in systemic inflammatory response syndrome（SIRS） patients. METHODS： 50 SIRS patients were enrolled, divided into two groups as to whether they got MODS. Thyroid hormone measurements were taken, including total T3（TT3）, total T4（TT4）, free T3（FT3）, free T4（FT4） and TSH. The acute physiology and chronic health evaluation Ⅱ （ APACHE Ⅱ ） score was calculated according to clinical data. Outcome （ recovery or deterioration） was recorded, as well as the length of time from the onset of SIRS to the day when thyroid hormones were measured （the duration of SIRS）. RESULTS： Euthyroid sick syndrome （ESS） was presented in 45 cases. TT3 level was negatively correlated with APACHE Ⅱ score （ r = - 0.330, P 〈 0.05）, and TT3/TT4 value was negatively correlated with the duration of SIRS （ r = - 0.316,P 〈 0.05）. TT3, TT4 and FT3 levels in the MODS patients were significantly lower than those in the patients without MODS （ P 〈0.05）. MODS patients got low TT4 or FT4 levels more frequently than those without MODS （ P 〈 0.05）. Compared to the normal TSH group, patients with low TSH had lower T3 and Ta, higher APACHE Ⅱ scores, higher proportion of MODS, and higher proportion of recovery, but no differences were observed （P 〉 0.05）. CONCLUSION： SIRS patients has high possibility to get ESS,which happens more frequently and severely in MODS patients. With the persistence and aggravation of SIRS, there is a progression of thyroid hormone reduction.