探讨NTIS在ICU重症患者的预后影响

Effect of Nonthyroidal Illness Syndrome on Prognosis of Critically Ill ICU Patients

目的:观察NTIS在ICU重症患者中的发病情况,及对病情的预后。方法:2010年1月到2010年3月,收集上海交通大学附属第六人民医院重症监护病房ICU收治的患者共161例。根据甲状腺功能情况分组。记录其年龄、性别、血糖、血白蛋白、肝肾功能、电解质、白细胞、血气、心率、血压等,统计有创呼吸机的使用率、使用天数、APACHEII评分、ICU住院天数和住院期间的死亡率,分析相关的影响因素。结果:161例入住ICU的重症患者中74例伴有NTIS(45.96%),血清游离三碘甲状腺原氨酸(FT3)水平是ICU住院时间的独立影响因素,低T3与住院期间死亡率明显相关,是主要死亡危险因子;NTIS患者较正常甲状腺患者死亡风险增加2.93倍(95%CI,1.052～8.182)。结论:低T3在重症疾病患者中发病常见,与住院期间死亡率明显相关,对于预测患者病情的严重程度和预后有重要的价值。

Objective：To investigate the prevalence of low T3 syndrome in patients with severe disease and explore the effect T3 syndrome on outcome of the severe disease.Methods：One hundred and sixty-one patients with severe disease admitted to Intensive care unit（ICU） underwent examinations of thyroid function and were further categorized according to thyroid hormone profile.The records of the ventilation utilization,the days of utilization,the length of stay in the ICU,mortality during hospitalization were evaluated,and the related factors were analysed.Result：Seventy-four of the 161patients（45.96%） with low T3 syndrome.Free triiodothyronine（FT3） was the independent influential factor for length of hosp ital stay.Low FT3 was significantly correlated with mortality during hospitalization..It was revealed by multivariate Cox regression analysis that FT3 was the chief predictor for cumulative death（risk ratio,2.93;95% confidential interval,1.052-8.182）.Conclusion：The prevalence of low T3 syndrome in patients with severe disease reach to 50%,and low T3 syndrome plays an important role in predicting the disease severity and outcome.