ICU重症感染患者甲状腺激素水平与预后关联性研究

The correlation between the levels of thyroid hormone and prognosis in ICU patients with severe infections

目的探讨重症监护室(ICU)重症感染患者血清甲状腺激素水平与预后的相关性。方法选择2015-01~2016-06该院ICU收住的重症感染患者65例作为感染组,根据28 d内的生存情况将患者分为存活组(n=38)和死亡组(n=27)两个亚组,另选取60例未合并感染的患者作为非感染组,比较各组患者血清甲状腺激素水平和急性生理及慢性健康状况评分(APACHEⅡ评分),并分析甲状腺激素水平与APACHEⅡ评分和预后的关系。结果感染组患者三碘甲状腺原氨酸(T_3)、四碘甲状腺原氨酸(T_4)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺(FT_4)水平均明显低于非感染组(P<0.05),而APACHEⅡ评分明显高于非感染组(P<0.05),两组促甲状腺激素(TSH)水平比较差异无统计学意义(P>0.05)。死亡组患者T_3、T_4、FT_3、FT_4水平均明显低于存活组(P<0.05),而APACHEⅡ评分明显高于存活组(P<0.05),两组TSH水平比较差异无统计学意义(P>0.05)。T_3、T_4、FT_3、FT_4水平与APACHEⅡ评分呈明显负相关(P<0.05)。结论 ICU重症感染患者血清甲状腺激素水平明显下降,与APACHEⅡ评分呈负相关,对患者预后评估具有一定临床价值。

Objective To explore the correlation between the levels of thyroid hormone and prognosis in intensive care unit（ICU） patients with severe infections.Methods A total of 65 ICU patients with severe infections from January 2015 to June 2016 in our hospital were selected as the infection group and they were divided into the survival subgroup（n=38）, and the death subgroup（n=27） according to the survival within twenty-eight days. The other 60 matched patients without infections were selected as the non-infected group. The serum levels of thyroid hormone and APACHE Ⅱ scores were compared among the groups,and the correlation between the levels of thyroid hormone and APACHE Ⅱ scores and the prognosis was ananalyzed.Results The levels of T3, T4, FT3 and FT4 in the infection group were significantly lower than those in the non-infected group（P〈0.05）. The APACHE Ⅱ scores of the infection group were significantly higher than those of the non-infected group（P〈0.05）, however there were no signigicant differences in the levels of TSH between the two groups（P〉0.05）. The levels of T3, T4, FT3 and FT4 in the survival subgroup were significantly lower than those in the death subgroup（P〈0.05）, but the APACHE Ⅱ scores of the survival subgroup were significantly higher than those of the death subgroup（P〈0.05）. There were no significant differences in the levels of TSH between the two subgroups（P〉0.05）. The levels of T3, T4, FT3 and FT4 were negatively correlated with the APACHE Ⅱ scores（P〈0.05）.Conclusion The serum levels of thyroid hormone decline in the ICU patients with severe infections, and are negatively correlated with the APACHE Ⅱ scores（P〈0.05）.