脓毒血症与急性心肌梗死中甲状腺激素水平的差异及激素的预后意义

Difference of Thyroid Hormone Level between Sepsis and Acute Myocardial Infarction and the Value of Thyroid Hormone in Prognosis

目的:探讨脓毒血症及急性心肌梗死患者甲状腺激素水平之间的差异及可能造成此类差异的原因,以及甲状腺激素与患者预后的关系。方法:回顾性分析本院2012年6月-2014年2月收治的74例脓毒血症及90例急性心肌梗死患者的临床资料,记录患者不同预后、入科第2天所测甲状腺功能五项指标(T_3、T_4、FT_3、FT_4,TSH)及降钙素原(PCT)、入科后24h内急性生理和慢性健康(APACHE-Ⅱ)评分。比较不同疾病患者甲状腺激素水平、PCT水平及APACHE-Ⅱ评分,据患者不同转归,分为好转组(M组)、自动出院组(Q组)及死亡组(D组),比较各组甲状腺激素水平,分析APACHE-Ⅱ评分与甲状腺激素水平相关性。结果:脓毒血症组T_3、T_4、FT_3及FT_4水平均低于急性心肌梗死组,PCT水平高于急性心肌梗死组,比较差异均有统计学意义(P<0.01):D组T_3、T_4、FT_3水平均低于M组,比较差异均有统计学意义(P<0.05);Q组甲状腺激素水平均值位于M组及D组之间,但比较差异均无统计学意义(P>0.05);Q、D组APACHE-Ⅱ评分高于M组,比较差异有统计学意义(P<0.05);T_3、T_4及FT_3与APACHE-Ⅱ评分存在负相关(P<0.01),APACHE-Ⅱ评分与TSH存在正相关(P<0.05),APACHE-Ⅱ评分与FT_4无相关性(P>0.05)。结论:除TSH外,脓毒血症患者甲状腺激素水平均低于急性心肌梗死患者;甲状腺激素水平与患者预后存在相关性。

Objective：To investigate the differences of serum thyrdd hormone levels in sepsis and acute myocardial infarction patients and its reasons,to explore the correlation of serum thyrdd hormone levels and patients＇ prognosis.Method：The clinical data of 74 patients with sepsis and 90 patients with acute myocardial infarction in our hospital from J une 2012 to February 2014 were retrospectively analyzed.The different outcomes of patients,the levels of thiiodothyronine（T_3）,thyroxine（T_4）,free triiodothyronine（FT_3）,free thyroxine（FT_4）,thyrdd stimulating hormone（TSH）,procalcitonin（PCT） and the APACHE- Ⅱ score within 24 hours of being admitted were recorded.The thyrdd hormone levels,PCT level and APACHE- Ⅱ score were compared in patients with different diseases.According to patients＇ different outcomes,they were divided into the better group（group M）,the automatic discharge group（group Q） and the death group（group D）.The thyrdd hormone levels were compared among the three groups.The correlation of APACHE-Ⅱscore and thyrdd hormone levels were analyzed.Result：The levels of T_3,T_4,FT_3 and FT_4 in the sepsis group were significantly lower than those in the acute myocardial infarction group,but the level of PCT in the sepsis group was higher than that in the acute myocardial infarction group,the differences were all statistically significant（P〈0.01）.The levels of T_3,T_4 and FT_3 in group D were lower than those in group M,the difference was statistically significant（P〈0.05）.The thyrdd hormone levels in group Q were higher than those in group D and lower than those in group M,but the differences were not statistically significant（P〉0.05）.The APACHE-Ⅱ score in group Q and group D was higher than that in group M,the difference was statistically significant（P〈0.05）.The APACHE-Ⅱ score had negative correlation with the levels of T_3,T_4 and FT_3（P〈0.01）,positive correlation with the level of TSH（P〈0.05） and no correlation with the level of FT_4.Conclusion：The thyrdd hormone levels（except the level of TSH） of sepsis patients are lower than those of acute myocardial infarction patients.There are some relationships between the levels of thyrdd hormone and patients＇ outcomes.