非甲状腺疾病综合征对胃肠道肿瘤长短期预后影响

Short-and Long-term Prognosis of Non-thyroidal Illness Syndrome on Gastrointestinal Tumor

目的探讨胃肠道肿瘤手术患者游离三碘甲腺原氨酸(FT3)和炎性指标的关系,及非甲状腺疾病综合征(non-thyroidal illness syndrome,NTIS)对长短期预后影响。方法选择温州医科大学附属第一医院2013年10月~2014年2月胃肠道肿瘤手术患者资料75例,根据患者术前是否患有NTIS分为NTIS组18例和非NTIS组57例,所有病例均门诊或电话随访至死亡或2018年10月10日(随访约5年)。采用t检验或Wilcoxon秩和检验比较两组炎性指标,χ^2检验或t检验分析NTIS对长短期预后的影响,Kaplan-Meier生存曲线分析NTIS对5年生存的影响。结果入选胃肠道肿瘤手术患者75例,NTIS组(18例)中5年生存7例(38.9%),非NTIS组(57例)中5年生存47例(82.5%)。胃肠道肿瘤手术患者FT3在术前、术后不同时间点呈现先下降再上升趋势,炎性指标呈现先上升再下降趋势。Pearson相关性分析显示术后第2天FT3与C反应蛋白(CRP)及降钙素原(PCT)呈负相关(r=-0.473,P=0.000及r=-0.316,P=0.006)。NTIS组和非NTIS组基本情况比较,差异无统计学意义(P>0.05);NTIS组患者术前CRP高于非NTIS组,差异有统计学意义(5.62∶3.17,P=0.045)。NTIS组在短期疗效(术后并发症、住院天数、住院费用)指标方面和非NTIS组比较,差异无统计学意义(P>0.05)。NTIS组在长期疗效(5年生存率)指标方面高于非NTIS组,差异有统计学意义(38.9%∶82.5%,P=0.000)。Kaplan-Meier生存分析也提示NTIS为5年生存不利因素(Log-rank检验,P=0.000)。结论胃肠道肿瘤手术患者FT3与炎性指标中CRP、PCT可能呈负相关,炎性因子可能参与了NTIS。NTIS对短期预后无影响,是5年生存的不良预后因素。

Objective To discuss the relationship between free serum triiodothyronine (FT3) and inflammatory in patients undergoing gastrointestinal tumor surgery,and the effects of non-thyroidal illness syndrome (NTIS) on short-and long-term prognosis.Methods In a selecting data from October 2013 to February 2014,75 patients with gastrointestinal tumor surgery admitted to the First Hospital of Wenzhou Medical University were studied.The patients were divided into the NTIS group ( n =18) and the non-NTIS group ( n =57) according to whether the patients had the NTIS before surgery.All cases were followed-up by outpatient or telephone until death or October 10th,2018.The t test or the Wilcoxon rank sum test were applied to compared various inflammatory indicators between the NTIS group and the non-NTIS group.The chi-square test or t test were applied to analysis the effect of NTIS on short-and long-term prognosis.Kaplan-Meier survival curve analysis was used to evaluate the effect of NTIS on 5-year survival.Results Totally 75 cases gastrointestinal tumor surgery patients were selected.Among them,7 of the 18 patients (38.9%) in the NTIS group survived for 5 years,and 47 of the 57 patients (82.5%) in the non-NTIS group.In patients with gastrointestinal tumor surgery,FT 3 showed a tendency to decline and then rised at different points before and after surgery.While,inflammation indicators showed a tendency to rise and then decline.Pearson correlation analysis showed FT 3 had a negative correlation with Creactive protein (CRP) and procalcitonin (PCT) on day 2 after operation ( r =-0.473,P =0.000;r =-0.316,P =0.006;respectively).The NTIS group and the control group had no significant statistical significance in the baseline characteristics ( P >0.05).The NTIS group was higher than the non-NTIS group in CRP on preoperative (5.62 ∶ 3.17,P =0.045).The NTIS group and non-NTIS groups showed no statistically significant differences in short-term prognosis (post-operative complications,the length of hospital stay,the expenses of hospital stay)( P >0.05).The NTIS group was statistically higher in long-term prognosis (5-year survival rate) than the non-NTIS group (38.9%∶82.5%,P =0.000).Kaplan-Meier survival analysis suggested that NTIS was an unfavorable factor of 5-year survival ( Log-rank test,P <0.001).Conclusion In patients with gastrointestinal tumor surgery,FT3 has a negative correlation with CRP and PCT.Inflammatory factors may be involved in NTIS.NTIS has no effect on short-term prognosis in gastrointestinal tumor surgery patients.But it is a bad prognostic factor for 5 years of survival.