小剂量甲状腺素对重症肺炎感染性休克合并低T_3综合征患者血流动力学及炎性因子的影响

Effect of low dose thyroxine on hemodynamics and inflammatory cytokines in patients with severe pneumonia septic shock complicated with low T_3 syndrome

目的研究小剂量甲状腺素对重症肺炎(SP)感染性休克(IS)合并低T3综合征(LT3S)患者血流动力学及炎性因子的影响。方法选择2016年9月～2018年5月在大连市中心医院诊治的SP及IS合并LT3S患者99例进行研究。根据随机数字表法将其分为两组,其中观察组49例,对照组50例。对照组给予常规集束化治疗,观察组在对照组治疗基础上另给予小剂量左甲状腺素片,均连续治疗7 d。随访28 d,比较两组生存预后及用药安全性,比较治疗前后的甲状腺有关激素、血流动力学有关指标、肺功能及炎性因子。结果观察组随访28 d的生存率高于对照组,死亡率低于对照组(P <0.05)。治疗后,观察组的总三碘甲状腺原氨酸(T_3)、总甲状腺素(T_4)及游离T3(FT_3)水平高于对照组,促甲状腺激素(TSH)低于对照组(P <0.05);观察组的全身血管阻力指数(SVRI)、平均动脉压(MAP)及中心静脉压(CVP)水平高于对照组,肺血管阻力指数(PVRI)、左心做功(LCW)、右心做功(RCW)、心脏指数(CI)及每搏指数(SI)低于对照组(P <0.05);两组的肺功能有关指标比较,差异无统计学意义(P>0.05),而治疗后观察组肿瘤坏死因子-α(TNF-α)及白细胞介素-6(IL-6)水平低于对照组(P <0.05);两组不良反应总发生率比较,差异无统计学意义(P> 0.05)。结论应用小剂量甲状腺素治疗SP及IS合并LT3S,能够较好地改善患者的预后,且对甲状腺有关激素、血流动力学及炎性因子均有明显的改善效果,用药安全性较高,值得给予推广。

Objective To investigate the effects of low dose thyroxine on hemodynamics and inflammatory factors in patients with severe pneumonia(SP)septic shock(IS)complicated with low T3 syndrome(LT3S).Methods A total of 99 patients with SP and IS combined with LT3S who were treated in Dalian Municipal Central Hospital from September 2016 to May 2018 were selected for the study.According to the random number table method,the patients were divided into two groups,49 cases in the observation group and 50 cases in the control group.The control group was treated with conventional cluster therapy,and the observation group was given a small dose of levothyroxine Tablets on the basis of the treatment of the control group,and the treatment lasted for 7 days.The patients were followed up for 28 days,and the survival prognosis and drug safety of the two groups were compared.Thyroid hormones,hemodynamic indicators,lung function and inflammatory factors before and after treatment were compared.Results The survival rate in the observation group was higher than that in the control group,and the mortality was lower than that in the control group(P<0.05).After treatment,triiodothyronine(T3),tyroxine(T4)and free thriiodothyronine(FT3)levels in the observation group were higher than those in the control group,and thyroid stimulating hormone(TSH)level was lower than that in the control group(P<0.05).The whole body vascular resistance index(SVRI),mean arterial pressure(MAP)and central venous pressure(CVP)in the observation group were higher than those in the control group,while the pulmonary vascular resistance index(PVRI),left ventricular work(LCW),right ventricular work(RCW),cardiac index(CI)and stroke index(SI)in the observation group were lower than those in the control group(P<0.05).There was no significant difference in lung function between the two groups(P>0.05),while the levels of TNF-αand IL-6 in the observation group were lower than those in the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P>0.05).Conclusion The treatment of SP and IS combined with LT3S with low dose thyroxine can better improve the prognosis of patients,and has obvious improvement effect on thyroid hormones,hemodynamics and inflammatory factors.The drug IS safe and worthy of promotion.