低三碘甲状腺原氨酸综合征对脓毒血症患者病情严重程度及预后影响的研究

Effec to fLow T3 Syndrome on the State of Severity and Prognosis in Patients with Sepsis

目的:探讨低三碘甲状腺原氨酸(T3)综合征对脓毒血症患者病情严重程度及预后影响。方法:回顾性分析2017年1月-2019年1月商丘市第一人民医院收治的诊断为脓毒血症的患者112例。根据甲状腺功能分为甲状腺功能正常组(85例)和低T3组(27例),回顾性收集所有患者的年龄、性别、吸烟史、高血压、糖尿病等一般临床资料。入院次日抽血检测FT3、FT4、TSH、白细胞计数(WBC)、中性粒细胞与淋巴细胞比值(NLR)、血肌酐(Scr)、C反应蛋白(CRP)、降钙素原(PCT)、血乳酸(Lac)。采用多因素logistic回归分析脓毒血症患者的危险因素。采用Kaplan-Meier法绘制两组患者30天的生存曲线。结果:两组患者的年龄、性别、吸烟史、高血压、糖尿病、WBC、NLR、Scr差异无统计学意义(P>0.05);低T3组患者CRP、PCT和Lac显著高于甲状腺功能正常组,差异有统计学意义(P<0.05)。低T3组脓毒血症病情严重程度重于甲状腺功能正常组,差异有统计学意义(P<0.05)。多因素logistic回归分析显示,FT3、CRP、PCT和Lac均为脓毒血症患者的独立危险因素(P<0.05)。低T3组30天生存率显著低于甲状腺功能正常组,差异有统计学意义(P<0.05)。结论:低T3综合征可反映脓毒血症患者的病情严重程度,且预后不良。FT3水平在脓毒血症病情严重程度的判断及预后评估中具有重要价值。

Objective: To explore the effect of low triiodothyronine(T3) syndrome on the state of severity and prognosis of patients with sepsis. Methods: 112 patients with sepsis who were diagnosed in the hospital from January 2017 to January 2019 were analyzed retrospectively. According to thyroid function, they were divided into normal thyroid function group(n=85) and low T3 group(n=27). The general clinical data of all patients including age, gender, history of smoking, hypertension and diabetes were collected retrospectively. FT3, FT4, TSH, white blood cell count(WBC), neutrophil to lymphocyte ratio(NLR), serum creatinine(Scr),C-reactive protein(CRP), procalcitonin(PCT) and blood lactic acid(Lac) were detected on the second day of admission. Multivariate logistic regression was used to analyze the risk factors of patients with sepsis. Kaplan-Meier method was used to draw the 30-day survival curve of the two groups of patients. Results: There were no statistically significant differences in age, gender, history of smoking, hypertension, diabetes, WBC, NLR and Scr between the two groups of patients(P>0.05). CRP, PCT and Lac in low T3 group were significantly higher than those in normal thyroid function group, and the difference was statistically significant(P<0.05). The severity of sepsis in low T3 group was higher than that in normal thyroid function group, and the difference was statistically significant(P<0.05). Multivariate logistic regression analysis showed that FT3, CRP, PCT and Lac were independent risk factors for sepsis. The 30-day survival rate of the low T3 group was significantly lower than that of the normal thyroid function group,and the difference was statistically significant(P<0.05). Conclusion: Low T3 syndrome can reflect the severity of the disease in patients with sepsis, and the prognosis of the patients with low T3 syndrome were poor. FT3 level plays an important role in the evaluation of sepsis severity and prognosis.