Low T3 vs low T3T4 euthyroid sick syndrome in septic shock patients:A prospective observational cohort study

BACKGROUND Both phases of euthyroid sick syndrome(ESS)are associated with worse prognosis in septic shock patients.Although there are still no indications for supplementation therapy,there is no evidence that both phases(initial and prolonged)are adaptive or that only prolonged is maladaptive and requires supplementation.AIM To analyze clinical,hemodynamic and laboratory differences in two groups of septic shock patients with ESS.METHODS A total of 47 septic shock patients with ESS were divided according to values of their thyroid hormones into low T3 and low T3T4 groups.The analysis included demographic data,mortality scores,intensive care unit stay,mechanical ventilation length and 28-day survival and laboratory with hemodynamics.RESULTS The Simplified Acute Physiology Score II score(P=0.029),dobutamine(P=0.003)and epinephrine requirement(P=0.000)and the incidence of renal failure and multiple organ failure(MOF)(P=0.000)were significantly higher for the low T3T4.Hypoalbuminemia(P=0.047),neutrophilia(P=0.038),lymphopenia(P=0.013)and lactatemia(P=0.013)were more pronounced on T2 for the low T3T4 group compared to the low T3 group.Diastolic blood pressure at T0(P=0.017)and T1(P=0.007),as well as mean arterial pressure at T0(P=0.037)and T2(P=0.033)was higher for the low T3 group.CONCLUSION The low T3T4 population is associated with higher frequency of renal insufficiency and MOF,with worse laboratory and hemodynamic parameters.These findings suggest potentially maladaptive changes in the chronic phase of septic shock.

Changes in thyroid function in patients with liver failure and their clinical significance:A clinical study of non-thyroidal illness syndrome in patients with liver failure

Background:Non-thyroidal illness syndrome(NTIS)develops in a large proportion of critically ill patients and is associated with high risk for death.We aimed to investigate the correlation between NTIS and liver failure,and the short-term mortality of patients with these conditions.Methods:The clinical data of 87 patients with liver failure were collected retrospectively,73 of them were randomly selected for an observational study and to establish prognostic models,and 14 for model validation.Another 73 sex-and age-matched patients with mild chronic hepatitis were randomly selected as a control group.Serum free triiodothyronine(FT3),free thyroxine(FT4),and thyroid-stimulating hormone(TSH)were measured.The clinical characteristics of patients with liver failure and NTIS were analyzed.The follow-up of patients lasted for 3 months.Additionally,the values for predicting short-term mortality of model for end-stage liver disease(MELD),Child-Turcotte-Pugh(CTP),chronic liver failure-sequential organ failure assessment(CLIF-SOFA)scores,FT3-MELD model,and FT3 were evaluated.Results:The observation group had significantly lower FT3(2.79±0.71 vs.4.43±0.75 pmol/L,P<0.001)and TSH[0.618(0.186-1.185)vs.1.800(1.570-2.590)mIU/L,P<0.001],and higher FT4(19.51±6.26 vs.14.47±2.19 pmol/L,P<0.001)than the control group.NTIS was diagnosed in 49 of the patients with liver failure(67.12%).In the observation group,patients with NTIS had a higher mortality rate than those without(63.27%vs.25.00%,P=0.002).Across the whole cohort,the 3-month mortality was 50.68%.The international normalized ratios(INR)were 2.40±1.41 in survivors and 3.53±1.81 in deaths(P=0.004),the creatinine(Cr)concentrations were 73.27±36.94μmol/L and 117.08±87.98μmol/L(P=0.008),the FT3 concentrations were 3.13±0.59 pmol/L and 2.47±0.68 pmol/L(P<0.001),the MELD scores were 22.19±6.64 and 29.57±7.99(P<0.001),the CTP scores were 10.67±1.53 and 11.78±1.25(P=0.001),and the CLIF-SOFA scores were 8.42±1.68 and 10.16±2.03(P<0.001),respectively.FT3 was negatively correlated with MELD score(r=−0.430,P<0.001).An FT3-MELD model was established by subjecting FT3 concentration and MELD score to logistic regression analysis using the following formula:Logit(P)=−1.337×FT3+0.114×MELD+0.880.The area under the receiver operating characteristic(ROC)curve was 0.827 and the optimal cut-off value was 0.4523.The corresponding sensitivity and specificity were 67.6%and 91.7%.The areas under the ROC curve for FT3 concentration,MELD score,CTP score,and CLIF-SOFA score were 0.809,0.779,0.699,and 0.737,respectively.Conclusions:Patients with liver failure often develop NTIS.FT3-MELD score perform better than CTP and CLIF-SOFA scores in predicting mortality in patients with liver failure.Thus,the FT3-MELD model could be of great value for the evaluation of the short-term mortality of such patients.

Thyroxine treatment for elderly patients with heart failure and sick euthyroid syndrome

Objectives To evaluate the effect of thyroid hormone therapy with low dose of thyroxin on cardiac function in elderly patients with heart failure and sick euthyroid syndrome.Methods Forty-seven patients(33 males and 14 females,mean age 85.9+4.6 years,ranging from 80 to 99 years)with chronic heart failure(NYHAⅡ-Ⅳ)and low triiodothyronine(T_(3))state were randomly allocated to the treatment group or control group.The treatment group patients received oral administration of levothyroxine sodium(Euthyrox)25-50mg/d in addition to conventional therapy of heart failure,whereas patients in control group were given conventional therapy only.Serum level of total T_(3)(TT_(3)),free T_(3)(FT_(3)),total thyroxine(TT_(4)),free thyroxine(FT_(4)),and thyroid-stimulating hormone(TSH)were determined.For both groups,left ventricular ejection fraction(LVEF)and stroke volume(SV)were assessed by two-dimensional echocardiography before and at 8 weeks after treatment.The changes of these parameters after the treatment were evaluated by adjusting heart rate in the two groups.Results The reduced serum T_(3) level in the treatment group was corrected after thyroid hormone therapy,and these patients had a significant improvement in cardiac function after treatment.By contrast,in the control group only changes of serum TT_(3) and TT_(4) levels and SV and LVEF after treatment were statistically significant.The heart rate-adjusted mean SV and LVEF in both groups were also increased,which was significantly greater in the treatment group than in the control group.Conclusion In the elderly patients with heart failure and sick euthyroid syndrome,addition of thyroxine at a low dosage to the conventional treatment could effectively improve the low T_(3) state and cardiac function independent of changes of heart rate.

Anesthetic Management of a Patient with Sick Sinus Syndrome during General Anesthesia for Maxillofacial Surgery

Sick sinus syndrome (SSS) is a generalized abnormality of cardiac impulse formation. Patients with SSS occasionally need temporary pacing during general anesthesia. The most common issue arising in the perioperative period is electromagnetic interference with device function. We report a case of a 66-year-old man who required temporary cardiac pacing during maxillary cyst extirpation using electrocautery.

Headache and sick sinus syndrome:A case report

BACKGROUND Sick sinus syndrome is a common disease in cardiology.Typical symptoms include palpitations,dizziness,shortness of breath,chest tightness,and amaurosis.However,to date,there are no known reports of sick sinus syndrome presenting with headache.Whether there is a correlation between headache and sick sinus syndrome merits further research.In this report,we describe a case of headache induced by sick sinus syndrome.CASE SUMMARY A 73-year-old female patient presented to our department with the chief complaint of recurrent paroxysmal headache for more than 7 years.The patient described paroxysmal palpations,usually headache occurring after palpitation.Her blood pressure was normal when the most recent headache occurred.A magnetic resonance imaging study and magnetic resonance angiography of the head at another center were normal.A clinical neurological examination was negative.A 24-h Holter electrocardiogram monitoring study showed sick sinus syndrome.The patient received dual chamber pacing implantation and was administered drug therapy to control ventricular rate.The patient’s paroxysmal headaches and palpitations had resolved within 1 year,confirmed via a follow-up telephone call.CONCLUSION After dual-chamber pacing implantation and drug therapy administration to control the ventricular rate,the patient’s paroxysmal headaches and palpitations had resolved within 1 year,confirmed via a follow-up telephone call.We believe that the headaches were related to the patient’s sick sinus syndrome.

Sick sinus syndrome associated with hypopituitarism:a case report and literature review

Though an association between autoimmune diseases and sick sinus syndrome has been reported,there has been no report on the association of hypopituitarism and sick sinus syndrome.Herein,we provide the first case report of hypopituitarism accompanying sick sinus syndrome in a 51-year-old woman presented to our hospital with syncope due to cardiac arrest.The patient was successfully managed by pacemaker installation and hormone replacement therapy.

Rong Shuan Jiao Nang in the treatment of acute mountain sickness and high altitude myocardial ischemic syndrome in Yushu

To evaluate the therapeutic effects of Rong Shuan Jiao Nang （RSJN） on treatment of acute mountain sickness （AMS） and high altitude myocardial ischemic syndrome in workers in Yushu, three groups were studied： group A （60 patients with AMS, given RSJN）, group B （15 patients with altitude myocardial ischemic syndrome, given RSJN）, and group C （control, without drugs）. All studied subjects were lowland workers who were first time entry to Yushu for work at an altitude of 4 250 m. During the course of treatment, a routing physical examina- tion was performed, AMS Lake Louise Scores were estimated, arterial oxygen saturation （SaO2）, electrocardiography and hemoglobin concentration were measured before and after using RSJN for 10 days. In group A, the effective rate was 68 %, symptomatic improvement in 54 cases （90 %） within 5 days. In group B, the effective rate was 93 %, episodes of angina pectoris stopped in 12 patients within 3 - 7 days, one lasted 8 days. After treatment, the level of SaO2 increased 15.5 %, 21.8 % and 5.6 % in group A, group B and group C, respectively. RSJN tak- en at the start of the arrival at Yushu can decrease AMS scores and facilitate cure. If taken after the illness has begun, RSJN may help lessen symptoms, especially effectively improved angina pectoris of the high altitude myocardial ischemic syndrome. Symptoms usually subside after 3 - 8 days. RSJN should be continually used lbr at least 7 days after ascent.

Efficacy and safety of Mahuang Fuzi Xixin Decoction on sick sinus syndrome： Ameta – analysis

Objective： To evaluate the efficacy and safety of Mahuang Fuzi Xixin Decoction on sick sinus syndrome andprovide evidence for clinical practice. Methods： Randomized controlled trials of all the languages of MahuangFuzi Xixin Decoction on sick sinus syndrome were collected by computer search and manual retrieval. Theretrieval time was from January 2000 to January 2017. According to the inclusion and exclusion criteria, 2reviewers independently selected and extracted data, then evaluated the quality, cross-checked the information andevaluated the quality of menthodology. Through discussion or third reviewer to help solve the divergence, RevMan5.3 software was used to perform meta analysis. Results： A total of 7 documents （n = 612） were finally enrolled,with 358 in Mahuang Fuzi Xixin Decoction group （treatment group） and 254 in control group. Meta analysisshowed that the treatment （86.9%） was more effective than the control （70.1%）, the difference was statisticallysignificant （RR = 1.25, 95% CI：（1.15-1.37）, P 〈 0.001）; the treatment （17.0%） was safer than the control （49.8%）,the difference was statistically significant （RR=0.23,95% CI：（0.06-0.93）, P =0.04）. Conclusion： The existingclinical studies suggest that Mahuang Fuzi Xixin Decoction on sick sinus syndrome is effective and safe; due to thelimited quality of the enrolled documents, the above conclusions need more high-quality randomized controlledtrials to be verified.

ANALYSIS OF LONG-TERM EFFECT OF ACUPUNCTURE ON 29 CASES WITH SICK SINUS SYNDROME(SSS)

In order to observate the long-term effect of acupuncture on SSS,the folow-uPsurvey was done after average 10.5 months on such aspects as patients’condition stability,symptoms,ECG examination and late clinical curative effect,etc.The results indicated,the obvious effect ratewas 55.17％,the total effective rate 82.76％,the late result decreased in some extent comparedwith those when leaving hospital,but there’s no statistical significance（P】0.05）.So,the longeerm effect of acupuncture on SSS is stable and good enough.

Clinical and Electrophysiological Research on Sick Sinus Syndrome Treated with Acupuncture

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脓毒症患者发生正常甲状腺性病态综合征的相关因素

目的:评估脓毒症患者正常甲状腺性病态综合征(euthyroid sick syndrome,ESS)的患病率及其影响因素。方法:选择2017年1月—2023年1月上海市第一人民医院急诊危重病科诊断为脓毒症的365例患者的病例资料进行回顾性分析,收集患者的相关临床数据。根据是否合并ESS,将患者分为ESS组(103例)和非ESS组(262例)。评估脓毒症患者ESS的患病率,对其影响因素进行多因素Logistic回归分析,比较两组患者30 d的生存率,探索游离三碘甲腺原氨酸(free triiodothyronine,FT3)预测脓毒症患者死亡的最佳截断值。结果:脓毒症患者中合并ESS者有103例,占总病例数的28.2%。ESS组脓毒症严重程度重于非ESS组,差异有统计学意义(P<0.05);ESS组急性生理学和慢性健康评估Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、序贯器官衰竭(sequential organ failure assessment,SOFA)评分明显高于非ESS组(P<0.05);ESS组C反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)、血清淀粉样蛋白A(serum amyloid A,SAA)、白介素-6(interleukin-6,IL-6)均高于非ESS组;ESS组总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high-density liptein cholesterol,HDL-C)低于非ESS组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,PCT、IL-6、CRP、SAA、部分激活的凝血活酶时间(activated partial thromboplatin time,APTT)是脓毒症患者ESS发生的独立危险因素(OR值分别为1.105、1.006、1.005、1.009、1.033,95%CI分别为1.044~1.170、1.001~1.012、1.001~1.009、1.005~1.014、1.004~1.062,P<0.05)。ESS组30 d生存率显著低于非ESS组,Long-rank卡方检验值16.611,差异有统计学意义(P<0.05)。脓毒症患者FT3预测死亡的受试者工作特征曲线下面积(area under the curve,AUC)为0.924(95%CI 0.894~0.954)。血清FT3截断点为3.705 pmol/L,特异性为0.868,敏感性为0.950。结论:脓毒症患者的ESS发生率为28.2%,且预后不良;PCT、IL-6、CRP、SAA、APTT是脓毒症患者ESS发生的独立危险因素,HDL-C是保护性因素;FT3是脓毒症患者预测死亡的潜在新型生物标志物。

以伪装热为表现的儿童孟乔森综合征10例病例系列报告

背景以伪装热为表现的儿童孟乔森综合征病例常就诊于精神科、心理科以外的其他科室,这些科室医生对该病认识不足,患儿很难得到及时和正确的诊治,发病率可能被低估。目的 总结以伪装热为表现的孟乔森综合征儿童的临床资料,提高对该病的认识。设计病例系列报告。方法 回顾性纳入2022年1月至2024年1月在3个医院诊断以伪装热为表现的孟乔森综合征的连续住院病例。通过各医院管理信息系统采集病例性别、发病年龄、病程,就诊经历及治疗史,发热特征,体格检查,辅助检查等临床资料。主要结局指标发热特征。结果 10例患儿进入本文分析,均为女童,起病年龄12(10~14)岁,病程6.3(1~18)个月。门诊频次平均8(4~12)次,住院频次平均3.5(2~5)次,就诊医院数平均3.5(3~5)家。均有反复行糖皮质激素、抗菌药物治疗史且均无疗效。均在短时间内体温达到高热(39.0~40.2℃),约5 min内体温恢复正常;6例偶有头晕,其中伴头痛2例,伴腹痛1例;发热前均无畏寒及寒战,时间无规律性;体温恢复正常时无出汗反应。发热前后皮肤体感温度、脉搏、心率、呼吸频次均未见变化。精神和食欲均正常;体重轻度增加3例,余病例均未见下降;均无阳性体征。辅助检查均未见异常。单亲家庭环境4例,父母长期争执、吵闹5例,留守儿童1例。均转至心理科进行干预,随访时间8(5~12)个月,未见类似发热发作,也无因其他症状就诊者。结论 以伪装热为表现的儿童孟乔森综合征好发于女性儿童/青少年,多次反复求治于不同医院,体温可在3~8 min内达到高热,约5 min内恢复正常,发作时无发热时典型病理生理过程变化,实验室检验和辅助检查结果无异常;虽然病程较长,但无疾病状态改变。

辨证论治以减少血清病治疗中激素的应用

将中医“辨证论治”思维与现代医学对于糖皮质激素作用机制的认识相结合,提出通过辨证运用中药可替代激素调用肾阴、引水救火之功效,进而减少激素对血清病患者的不良反应,不伤其肾阴,最终达到安全有效治愈患者的目的。临证中将血清病主要辨证为风热犯表、热毒入营、邪犯肺卫以及风湿热痹4种证型。风热犯表者,主以疏风清热,解表止痒;热毒入营,则应清热凉血,解毒护阴;邪犯肺卫者,着重辛凉透表,清宣肺卫;风湿热痹,则需清热利湿,宣痹通络。

病态窦房结综合征动物模型的研究进展

病态窦房结综合征(sick sinus syndrome,SSS)是窦房结及其周边组织发生了损伤,使窦房结发生了兴奋、传导功能紊乱,从而引起了一系列的心律失常疾病。为更好地探索SSS发病机制,并为其治疗研究提供依据,建立出能够模拟人类窦房结功能紊乱的动物模型具有重要价值。本文从动物选择、造模原理及方法、模型评价方法及检测指标等方面进行综述,希望能够为更加深入研究SSS致病机制提供基础和依据。

心房颤动伴长间歇的治疗策略:共识与争议

心房颤动(房颤)是心血管疾病中最为常见的心律失常,其常与病态窦房结综合征并存且相互作用。既往临床上对于有症状的房颤伴长间歇治疗多倾向于植入心脏起搏器联合抗心律失常药物,但近年来越来越多的研究表明,与植入起搏器相比,射频消融能降低房性心动过速相关心律失常的住院率、有效控制房颤,改善患者预后及心力衰竭住院率。但同时部分患者存在固有窦房结功能障碍(SND),且SND可在部分患有房颤的患者中逐渐进展及加重。因此,房颤伴长间歇患者的一线治疗策略仍存在争议。本文以房颤伴长间歇治疗策略的选择进行综述。

Cardiovascular mechanisms of thyroid hormones and heart failure:Current knowledge and perspectives

A multiple hormonal imbalance that accompanies heart failure(HF)may have a significant impact on the clinical course in such patients.The non-thyroidal illness syndrome(NTIS),also referred to as euthyroid sick syndrome or low triiodothyronine syndrome,can be found in about 30%of patients with HF.NTIS represents a systemic adaptation to chronic illness that is associated with increased cardiac and overall mortality in patients with HF.While conclusions on thyroid-stimulating hormone,free triiodothyronine,total and free thyroxine are currently unresolved,serum total triiodothyronine levels and the ratio of free triiodothyronine to free thyroxine seem to provide the best correlates to the echocardiographic,laboratory and clinical parameters of disease severity.HF patients with either hyper-or hypothyroidism should be treated according to the appropriate guidelines,but the therapeutic approach to NTIS,with or without HF,is still a matter of debate.Possible treatment options include better individual titration of levothyroxine therapy,combined triiodothyronine plus thyroxine therapy and natural measures to increase triiodothyronine.Future research should further examine the cellular and tissue mechanisms of NTIS as well as new therapeutic avenues in patients with HF.

刘如秀从心肾论治病态窦房结综合征经验

病态窦房结综合征(sick sinus syndrome,SSS)是由窦房结起搏功能受损和或冲动传导功能障碍引发的一种难治性心律失常性疾病,主要表现为心动过缓、窦性停搏、慢快综合征、头晕、晕厥、乏力等症状。目前植入人工起搏器是SSS最有效治疗方式,但存在诸多不良反应及禁忌证,且不降低病死率。因此,寻求安全有效的治疗方式成为亟待解决的问题。刘如秀教授传承创新国医大师刘志明学术思想,提出从心肾论治SSS,采用温肾、通阳、活血等疗法,临床疗效显著。

基于网络药理学及分子对接技术探究麻黄细辛附子汤治疗病态窦房结综合征的作用机制

目的利用网络药理学和分子对接技术研究麻黄附子细辛汤治疗病态窦房结综合征(Sick sinus syndrome,SSS)的活性成分及其潜在作用机制。方法采用GeneCards、OMIM、Disgent等数据库内容,结合TCMSP数据库,获得麻黄附子细辛汤药效物质基础及相应的靶点。利用Uniprot数据库,对靶点展开基因注释,利用Cytoscape3.9.0软件,构建出一个网络图。再基于STRING数据库构建蛋白网络互作(PPI)图,根据“介数中心”、“紧密密度”、“结点链接”为筛选条件,筛选后获得麻黄附子细辛汤治疗SSS的核心靶点,结合DAVID数据库,采用GO、KEGG等技术,使用AutoDock软件对疾病核心靶基因与潜在活性成分进行分子对接,以Pymol软件为平台,实现“关键靶点”的可视化。结果获得麻黄附子细辛汤75种有效成分和646个作用靶点,SSS疾病靶点1287个,其中麻黄附子细辛汤与SSS的交集靶点108个,包括NR3C1、AKT1、ESR1、TNF、CASP3、EGFR 6个核心靶点。筛选结果显示,GO项有697个,KEGG信号通路有137个。通过分子对接,发现其与靶标蛋白的相互作用能力良好。结论本研究提出了“多组分-多靶点-多途径”的药效物质基础,为临床应用提供了依据。

齐鲁卢氏内科流派益气温阳法治疗病态窦房结综合征经验

病态窦房结综合征是临床常见难治病。齐鲁卢氏内科流派着眼于“虚-寒-瘀-痰”,认为该病病机以心气心阳虚损为本,寒凝、血瘀、痰阻为标,治以益气温阳、祛瘀化痰通络,疗效显著。附益心复脉汤及验案1则。

基于网络药理学与分子对接探究附子-丹参治疗病态窦房结综合征的药理机制

目的利用网络药理和分子对接技术,探究附子-丹参药对治疗病态窦房结综合征(sick sinus syndrome,SSS)的作用机制。方法通过TCMSP数据库检索并筛选附子、丹参的有效成分及其对应靶点;利用DisGeNET、GeneCards、OMIM数据库预测SSS治疗靶点;借助韦恩图取交集,然后利用String数据库及Cytoscape 3.7.2进行PPI网络分析,通过拓扑分析得到关键靶点,利用Metascape数据库对靶点进行GO功能及KEGG富集分析,使用AutoDock软件对疾病核心靶基因与潜在活性成分进行分子对接,对接结果通过Pymol软件可视化。结果共挖掘出64种活性成分,77个靶点与改善SSS相关。治疗SSS的重要靶点涉及AKT1、TP53、IL-6、TNF、VEGFA等,主要作用于脂质和动脉粥样硬化通路、松弛素信号通路、钙信号通路、cAMP信号通路、NF-κB信号通路、细胞凋亡、脂肪细胞脂肪分解等信号通路。分子对接结果显示核心成分和核心靶点之间可稳定结合。结论附子-丹参可能通过AKT1、TP53、IL-6、TNF、VEGFA等靶点发挥抑制窦房结及周围组织纤维化、调节离子通道、保护心肌、阻止其他疾病对SSS的诱发等机制治疗SSS。