危重病人血清甲状腺激素的变化及其与APACHEⅡ评分和预后的关系

The relationship between the change of serum thyroid hormone and APACHE II scores in critically ill patients

目的 探讨危重病人血清甲状腺激素水平的变化及其与APACHEⅡ评分和危重病预后的关系。方法 应用放射免疫分析法及免疫放射分析法测定危重病人的血清甲状腺激素含量。危重病程度按APCHEⅡ评分系统进行评分。结果 危重病人的血清TT3 、TT4、FT3 、FT4含量明显低于正常对照组 (P <0 .0 0 1) ,而TSH的变化无显著性 (P >0 .0 5 ) ;危重病存活组与死亡组血清甲状腺激素之间的差异无显著性 (P >0 .0 5 ) ;不同APACHEⅡ评分分段下危重病人的血清甲状腺激素水平比较差异无显著性 (P >0 .0 5 ) ;而危重病人死亡组的APACHEⅡ评分明显高于存活组的APACHEⅡ评分 (P <0 .0 0 1)。结论 非甲状腺疾病的危重病人常出现甲状腺功能指标异常。血清甲状腺激素的变化不能作为判断病情的严重程度及评估预后的指标。而APACHEⅡ评分系统适用于危重病人严重程度及评估预后的评估。

Objectives To investigate the variety of serum thyroid hormone and APACHEII scores in critically ill patients, especially evaluates whether both parameters could predict the severity and outcome.Methods The concentrations of serum thyroid hormone were measured by radioimmunoassay and immunoradiometricassay in critically ill patients. The severe degree in critical illness were evaluate by APACHE II scores.Results The concentrations of serum total (TT 4), free thyroxine (FT 4), total (TT 3) and free tri-iodothyronine (FT 3) in critically ill patients were markedly lower than that observed in control group (P<0.001), whereas the concentration of serum thyrotropin (TSH) was no difference (P> 0.05). However, the concentration of the thyroid hormone was no difference between non-survivors and survivors, and also among groups with different APACHE II scores (P> 0.05). APACHE II scores were markedly higher in non-survivors than that in survivors (P< 0.001).Conclusions Abnormal level of thyroid hormone occurs in a variety of non-throidal critically ill patients. However, this change could not predict the severity and outcome in critical illness, which can only be assessed by the APACHE II scores. [