老年脓毒症患者甲状腺激素水平变化与临床意义

The changes and clinical significance of thyroid hormone levels in old patients with sepsis

目的探讨老年脓毒症患者甲状腺激素水平的变化及其与预后的关系。方法140例老年脓毒症患者，分别进行APACHEⅡ评分与SIRS评分，根据患者是否发生多器官功能不全综合征（MODS）及预后分为2组，比较其甲状腺激素的水平。结果老年脓毒症患者病情严重者，血清游离三碘甲状腺原氨酸（FT3）、游离甲状腺素（FT4）下降明显，APACHEⅡ评分和SIRS评分升高明显（P〈0．05或0．01），死亡组FT3、FT4水平明显低于存活组（均P〈0．05）。结论炎症反应和细胞因子对甲状腺轴具有一定影响，甲状腺激素水平可以反映老年脓毒症患者的病情，病情越重，甲状腺激素水平越低，越易发生MODS而死亡。

Objective To investigate the changes of thyroid hormone levels and its relationship with prognosis in old patients with sepsis. Methods APACHE Ⅱ score and SIRS score were documented in 140 old patients with sepsis ,who were divided into Muhiorgan dysfunction syndrome （MODS） group and non MODS group. Results The levels of FT3 and FT4 descended obviously and APACHE Ⅱ score and SIRS score increased remarkably in old patients with severe sepsis（P 〈0.05 or P 〈0.01 ）. The level of FT3 and FT4 in death group and MODS group was much lower than that in the survival group（ P 〈 0.05 ）. Conclusion Inflammatory reaction and cytokines may affect the hypothalamic-pituitary-thyroid axis. The levels of thyroid hormone can reflect old patients with sepsis condition. The patients with severer conditions may have lower levels of thyroid hormone who will be more likely to died of MODS.