脑外伤后低T3综合征患者预后不良的危险因素分析

Analysis on risk factors for poor prognosis in patients with low T3 syndrome after traumatic brain injury

目的分析脑外伤后低T3综合征患者预后不良的危险因素。方法回顾性分析2018年7月至2020年12月该院神经外科收治的302例中、重度脑外伤患者临床资料。出院后6个月进行随访,根据格拉斯哥预后评分(GOS评分)分为预后不良组和预后良好组。分析临床资料与预后的关系。结果低T3综合征患者142例,发病率47.02%。低T3综合征组患者与非低T3综合征组患者格拉斯哥昏迷评分(GCS评分)、赫尔辛基CT评分(HCT评分)、死亡率、手术率比较,差异均有统计学意义(P<0.001)。低T3综合征患者预后良好48例,预后不良94例。单因素分析显示,预后不良组与预后良好组年龄、GCS评分、HCT评分、白细胞、血糖、游离四碘甲状腺原氨酸(FT4)、三碘甲状腺原氨酸(T3)/四碘甲状腺原氨酸(T4)、瞳孔对光反射比较,差异均有统计学意义(P<0.05)。多因素分析结果显示,GCS评分低(OR=0.723,95%CI:0.538~0.971 P=0.031)、年龄高(OR=1.114,95%CI:1.051~1.181,P<0.001)、双侧瞳孔对光反射双侧消失(OR=7.211,95%CI:1.015~51.205,P=0.048)、FT4低(OR=0.487,95%CI:0.325~0.728,P=0.001)、白细胞高(OR=1.112,95%CI:1.002~1.236,P=0.046)是脑外伤后低T3综合征预后不良的独立危险因素。GCS评分(AUC=0.847,95%CI:0.783~0.911,P<0.001)、年龄(AUC=0.725,95%CI:0.637~0.813,P<0.001)、FT4(AUC=0.753,95%CI:0.667~0.840,P<0.001)对脑外伤后低T3综合征患者预后不良的预测能力较强。结论脑外伤患者检测甲状腺功能对于判断病情及预后有一定临床意义。

Objective To analyze the risk factors of the poor prognosis in the patients with low T3 syndrome after traumatic brain injury(TBI).Methods The clinical data of 302 cases of moderate to severe TBI treated in the neurosurgery department of the Affiliated Lianyungang Hospital of Xuzhou Medical University from July 2018 to December 2020 were analyzed retrospectively.The patients were followed up in 6 months after discharge and divided into the poor prognosis group and good prognosis group according to the Glasgow Outcome Scale(GOS)score.The relationship between the clinical data and prognosis was analyzed.Results There were 142 cases of low T3 syndrome,with an incidence rate of 47.02%.There were statistically significant differences in the Glasgow Coma Scale(GCS)score,Helsinki CT(HCT)score,mortality rate and operation rate between the low T3 syndrome group and the non-low T3 syndrome group(P<0.001).In the low T3 syndrome group,48 cases had the good prognosis and 94 cases had a poor prognosis.The univariate analysis showed that there were significant differences in age,GCS score,HCT score,white blood cell,blood glucose,FT4,T3/T4 and pupil light reflex between the poor prognosis group and good prognosis group.The multivariate analysis results showed that the GCS score(OR=0.723,95%CI:0.538-0.971,P=0.031),age(OR=1.114,95%CI:1.051-1.181,P<0.001),bilateral pupil light reflex positive(OR=7.211,95%CI:1.015-51.205,P=0.048),FT4(OR=0.487,95%CI:0.325-0.728,P=0.001)and white blood cell(OR=1.112,95%CI:1.002-1.236,P=0.046)were the independent risk factors of poor prognosis after TBI.The GCS score(AUC=0.847,95%CI:0.783-0.911,P<0.001),age(AUC=0.725,95%CI:0.637-0.813,P<0.001),FT4(AUC=0.753,95%CI:0.667-0.840,P<0.001)had strong predictive ability for the poor prognosis in the patients with low T3 syndrome after TBI.Conclusion Detecting the thyroid function in the patients with TBI has a certain clinical significance for judging the disease condition and prognosis.