脓毒症合并甲状腺激素水平异常与中医证型的相关性研究

Study on Correlation Between Abnormal Thyroid Hormone Level and TCM Syndrome in Sepsis

目的通过研究脓毒症合并甲状腺激素水平异常与中医证型的关系,以期检测甲状腺激素水平能够作为脓毒症中医辨证及病情进展的参考指标,提高中医对脓毒症的诊治能力。方法采用前瞻性研究方法,统计2016年2月1日至2017年2月28日入住东方医院和北京中医医院ICU的脓毒症合并甲状腺激素水平异常患者63例,进行虚证、实证、虚实夹杂证分组,并对其进行甲状腺激素的检测,研究脓毒症合并甲状腺激素水平异常与中医证型之间的关系。结果各组患者T3、FT3、T4水平比较差异均有统计学意义(P<0.05),且T3水平与虚实证型呈负相关(P<0.05),T4水平与虚实证型呈负相关(P<0.05);虚实夹杂证组和虚证组FT3水平比较差异无统计学意义(P>0.05);3组患者FT4、TSH水平比较差异无统计学意义(P>0.05)。结论虚证组和虚实夹杂证组FT3比较差异无显著性,提示机体一旦出现虚象症候,病情进展很快。临床上参考T3、FT3、T4水平,将有助于更加准确地判断脓毒症患者虚实辨证分型。

Objective： To detect thyroid hormone level as a reference index for TCM syndrome differentiation and disease progression of sepsis,and improve TCM diagnosis and treatment ability of sepsis by studying the relationship between sepsis and thyroid hormone level abnormality and TCM syndrome type. Methods： A prospective study was conducted. 63 patients with sepsis with abnormal thyroid hormone levels were divided into three groups： deficiency,empirical,and intermingled deficiency and excess. The thyroid hormone was detected and the relationship between the abnormal level of thyroid hormone and the syndrome type of TCM was studied. Results：The levels of T3,FT3 and T4 in the three groups were significantly different（P 00.05）,and T3 level was negatively correlated with the deficiency syndrome（r =-0.711,P 〈 0.05）;T4 level was negatively（P 〈 0.05）. There was no significant difference in the levels of FT4 and TSH between the two groups（P 〉 0.05）. There was no significant difference between the two groups（P 〈 0.05）. Conclusions： There was no significant difference in FT3 between the deficiency group and intermingled deficiency and excess group,which indicates that the disease was progressing rapidly. Clinical reference of T3,FT3 and T4 levels will help to more accurately determine the syndrome of patients with sepsis syndrome.