急性重症脑血管病患者甲状腺激素水平与APACHEⅡ评分的关系

Relationships between thyroid hormone levels and APACHEⅡ scores in patients with acute severe cerebrovascular disease

目的探讨重症脑血管病患者甲状腺激素水平与APACHEⅡ评分的关系及其疾病严重程度与预后.方法将113例急性脑血管患者进行血清T H水平测定.入院后所有患者进行格拉斯哥昏迷评分(GCS),评分≤8分为危重症组,评分>8分为轻中症组.其中危重组57例,轻中症组55例,比较2组甲状腺激素水平.对危重组患者入院24 h内进行APACHEⅡ评分,根据甲状腺激素水平分为低T3组和非低T3组(T4、TSH),比较2组APACHEⅡ评分,并将甲状腺激素水平与APACHEⅡ评分两变量间进行散点相关分析,最后根据甲状腺激素水平评估重症脑血管病患者的预后.结果危重症组FT3水平(2.887±0.307)pmol/L显著低于轻中症组(3.925±0.397)pmol/L(P<0.001),低FT3率明显高于对照组(P<0.01);FT4水平及低T4率差异均无统计学意义(P>0.05);危重症组TSH水平(1.150±0.251)μIU/mL明显低于对照组(2.505±0.684)μIU/mL(P<0.001),低TSH率比较差异无统计学意义(P>0.05).危重症组中低FT3组与非低FT3组比较,APACHEⅡ评分只与FT3水平有关,差异有统计学意义(P<0.05);散点相关分析显示,只有FT3与APACHEⅡ评分之间存在相关性(P<0.05).死亡组与存活组间甲状腺激素水平比较,FT3与患者生存率差异有统计学意义(P<0.05).结论对于急性脑血管病患者,病情越重,患者体内FT3水平越低,低T3发生率越高,TSH水平越低,低TSH发生率不变.在急性脑血管病危重症中,甲状腺激素水平(T 3)与病情严重程度相关,可判断重症脑血管病患者预后.

Objective To explore the relationships between thyroid hormone levels and APACHEⅡ scores in patients with severe cerebrovascular disease,and its severity and prognosis. Methods Determination of serum TH levels in 113 patients with acute cerebrovascular disease,all patients met the diagnostic criteria for ischemic cerebrovascular disease established in 2010 guidelines for the diagnosis and treatment of acute ischemic stroke in China.All patients were admitted to the Glasgow Coma Scale (GCS),with a score of ≤8 are classified into critical group,and a score of>8 are classified into moderate group.There were 57 patients in critical group,55 patients in moderate group,comparing thyroid hormone levels in the two groups.APACHEⅡ scores were performed within 24 hours in critical patients,according to the thyroid hormone levels,the low T3 group and the non low T3 group (T4,TSH) were compared,and the APACHEⅡ scores were compared between the two groups,and the APACHEⅡ scores were compared between the two groups,and a scatter correlation analysis was performed between the two variables of thyroid hormone level and APACHEⅡ score,finally,to evaluate the prognosis of patients with severe cerebrovascular disease based on thyroid hormone levels. Results The FT3 levels in the critical group (2.887±0.307) pmol/L was significantly lower than that in moderate group(3.925±0.397) pmol/L ( P <0.001),and the low FT3 rate was significantly higher than the control group ( P <0.01),there is no difference between FT4 levels and low T4 rate.The level of TSH in the critical group (1.150±0.251)μIU/mL was significantly lower than that in the control group (2.505±0.684)μIU/mL( P <0.001),there was no significant difference in the low TSH rate.Compared with the non low FT3 group,the APACHEⅡ score was only related to the FT3 level in the critical group,the difference was statistically significant ( P <0.05).The scatter correlation analysis showed that there was only a correlation between FT3 and APACHEⅡ scores ( P <0.05).There was a statistically significant difference in thyroid hormone levels between the death group and the survival group. Conclusion For patients with acute cerebrovascular disease,the more severe the condition,the lower the level of FT3 in patients,the higher rate of low T3,the lower the TSH level,the lower the rate of low TSH.In critical patients with acute cerebrovascular disease,thyroid hormone levels (T3) are associated with severity of the disease and can be used to determine the prognosis of patients with severe cerebrovascular disease.