ICU患者低T3综合征的发病率及其对患者预后的影响

The incidence of low triiodothyronine syndrome in ICU patients and its impact on the prognosis

目的:探讨低T3综合征在ICU患者中的发病率及对患者预后的影响。方法:选择2015年1月至2016年12月ICU收治的患者100例,将甲状腺功能检查结果符合低T3综合征诊断的患者作为低T3综合征组,共计38例,其余62例为非低T3综合征组。计算100例ICU患者中低T3综合征的发生率。随访30 d,比较各组存活率、死亡率及血清总三碘甲状腺原氨酸(TT3)水平、急性生理与慢性健康评分(APACHEⅡ评分),采用ROC曲线分析TT3水平和APACHEⅡ评分对患者预后的价值。结果:低T3综合征的发生率为38.0%。随访30 d,低T3综合征组患者病死率为42.1%,非低T3综合征组患者病死率为21.0%,低T3综合征组病死率高于非低T3综合征组(P<0.05)。低T3综合征组血清TT3水平低于非T3综合征组(P<0.05),APACHEⅡ评分高于非T3综合征组(P<0.05)。APACHEⅡ评分与TT3水平呈负相关(r=-0.614,P<0.05)。TT3水平和APACHEⅡ评分联合预测预后的曲线下面积(AUC)面积为0.894,敏感度为81.1%,均优于单独使用TT3水平和APACHEⅡ评分(P<0.05)。结论:伴发低T3综合征的ICU患者预后差,TT3值和APACHEⅡ评分可以作为危重症患者预后的参考指标。

Objective：To investigate the incidence of low triiodothyronine （13） syndrome in ICU patients and its impact on the prognosis. Methods：A total of 100 patients in ICU from January 2015 to December 2016 were selected as research objects. All of the patients were assigned into low 33 syndrome group （ n =38） and normal 33 group （ n =62）, according to the result of thyroid function test. The incidence of low 33 syndrome was calculated. All of the patients were followed up for 30 d. The survival rate, mortality rate, serum total triiodothyronine （ TT3 ） level and acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ） score were calculated. Results ：The incidence of low T3 syndrome was about 38%. After 30 days of follow - up, the mortality rate of patients in low T3 syndrome group was 42.1%, and the mortality rate was 21.0 % in normal T3 group. The mortality rate of the low T3 syndrome group was significantly higher than that of the normal T3 group, the difference statistically significant （ P 〈 0.05 ）. The serum T13 level in the low I3 syndrome group was lower than that in the normal T3 group （ P 〈 0.05 ）, and the A- PACHE II score was higher than that in the normal T3 group （ P 〈0.05）. The APACHE Ⅱ score was negatively correlated with the level of 3T3 （ r = - 0. 614, P 〈 0.05 ）. The prognostic area of TT3 combined with APACHE Ⅱ score was 0. 894 and the sensitivity was 81.1% , which were better than that of TT3 and APACHE Ⅱ （ P 〈0.05）. Conclusion：The prognosis of ICU patients with low 33 syndrome is poor, and the TT3 and APACHE Ⅱ scores can be used as a reference marker for the prognosis of critically ill patients.