内科危重患者甲状腺激素水平观察及预后评估

目的:探讨内科危重患者甲状腺激素(TH)水平与疾病严重程度、预后的关系。方法:对107例内科危重患者在入院3天内检测血清甲状腺激素(TT3、TT4、FT3、FT4、rT3和TSH)作为观察组,以同期住院的非危重患者83例作为对照组,并根据出院情况将观察组分为存活组和死亡组,分别比较两组间TH水平,存活组在出院前复查TH与入院时水平比较。分析TH异常与APACHEⅢ评分及病死率的关系,并比较低T3、低T4和低T3/rT3比值的预后价值。结果:观察组TT3、TT4明显低于对照组(P<0.01,P<0.05),rT3则显著升高(P<0.01);死亡组TT3、TT4均较存活组降低(P<0.01,P<0.05),而rT3升高(P<0.01);存活组治疗后TT3、TT4升高(P<0.01,P<0.05),而rT3降低(P<0.01),较治疗前有显著差异。观察组TT3、TT4、rT3三项指标的异常数与APACHEⅢ积分及病死率相关。低T3/rT3比值较低T3、低T4对预后的预测敏感性更高(95.5%比72.7%、54.5%,P<0.01),阴性预测值也高(97.8%比89.5%、87.0%,P<0.01)。多因素Logistic回归分析显示,低T3/rT3比值较低T3、低T4对危重患者的死亡危险有更高的独立预测价值OR22.54,比4.00(P<0.001)、4.47(P<0.01)]。结论:内科危重病患者体内T3、T4水平下降,rT3升高,且与疾病严重程度有相关,低T3、T4与低T3/rT3比值对内科危重患者的死亡危险均有重要预测价值,但低T3/rT3比值可能具有更高的独立预测性。

OBSERVATION ON LEVEL OF THYROID HORMONE AND EVALUATION OF PROGNOSIS IN INTENSIVE PATIENTS OF INTERNAL MEDICINE DEPARTMENT

Objective:To observe the change of thyroid hormone(TH)level in intensive patients of internal medicine department and investigate its relationship with the prognosis and the critical degree of disease.Methods:The levels of serum TH(TT3,TT4,FT3,FT4,rT3和TSH)in 107 intensive patients as the observed group hospitalized to rescue rooms in internal-medicine department during 9 months from Feb.to Sep.in 2004 were measured by direct chemiluminescence technology in 3 days after hospitalization.And were 83 non-intensive patients of their ages and sexes hospitalized at the same tine selected as control.The observed group was divided into the survivor group and the nonsurvivor group.The levels of TH between the two groups were compared respectively.The levels of TH in the survivor group were remeasured before their dischavge and compared with the former.The relationship of TH with APACHEⅢ and hospital mortality were studied according to the degree of TH abnormality.And the predicting values on prognosis of low levels of T3,T4 and T3/rT3 ratio were compared.Results:Levels of TT3 and TT4 in the observed group were evidently lower than those in the controls(P<0.01,P<0.05),while rT3 level was higher markedly(P<0.01);TT3 and TT4 levels in the nonsurvivor group were also lower than those in survivor group(P<0.01,P<0.05)with higher rT3 level(P<0.01);TT3 and TT4 levels became higher(P<0.01,P<0.05)with rT3 level lower(P<0.01)after treatment in the survivor group,which had significantly differences from the former.The number of abnormality among TT3,TT4,rT3 was positively correlated to APACHEⅢ score,while a significant correlation was seen between the number and the mortality.Low T3/rT3 ratio had a higher sensitivity(95.5% vs 72.7%,54.5%,P<0.01)and had an increased negative predicting value(97.8% vs 89.5%,87.0%,P<0.01)than the low level of T3 or T4.Multivariable logistic regression analysis revealed that low T3/rT3 ratio was of higher independently predicting value for death risk than the low level of T3 or T4 OR 22.54 vs 4.00(P<0.001),4.47(P<0.01)].Conclusions:The levels of T3 and T4 in intensive patients decreases,while the rT3 level increases ;which are correlated with the critical degree of disease.The changes of T3,T4 and T3/rT3 ratio all play an important role in the prediction of death risk in intensive patients,where as the low T3/rT3 ratio may demonstrate a more strong prognostic discriminatory capacity.