非甲状腺疾病综合征对老年住院患者预后判断价值

目的了解非甲状腺疾病综合征(NTIS)老年患者的甲状腺素水平变化,评估其在疾病预后判断中的价值。方法 2001年6月~2010年6月共448例老年患者纳入研究。住院期间检测患者血清游离三碘甲腺原氨酸(FT3)、血清游离甲状腺素(FT4)、促甲状腺激素(TSH)水平和炎症指标。了解NTIS的发病率并分析预后因素。结果 NTIS组患者C反应蛋白(CRP)、乳酸脱氢酶(LDH)、纤维蛋白原、血沉(ESR)水平明显高于非NTIS组。甲状腺水平越低,炎症标志物种类越多。NTIS组FT3水平明显低于非NTIS组,低FT3水平是唯一死亡预测因子。结论老年NTIS患者中低FT3水平是最敏感的独立的短期死亡预测因子。低FT3可以作为NTIS的预后指标。

Prognostic value of non-thyroidal illness syndrome in hospitalized elderly patients

Objective To document thyroid hormone abnormalities in elderly patients with non-thyroidal illness syndrome(NTIS,specifically low T3 syndrome) and identify markers of prognostic value.Methods From June 2001 to June 2010,448 acutely ill elderly patients(232 men,median age 77±11,range 65-99) were included.Circulating free thyroxin(FT3 FT4),thyrotrophic concentrations and acute inflammation indexes were evaluated in 448 elderly patients with NTIS.Data were analyzed to determine endocrine prognostic factors,and to document the prevalence of thyroid hormone abnormalities.Results CRP,LDH,fibrinogen,ESR levels in NTIS patients were significantly higher than non-NTIS group.The lower the level of the thyroid was,the more types of inflammation markers would appear.FT3 levels in NTIS group were significantly lower than the non-NTIS group,and low FT3 level was the only predictor of death.Conclusion Low FT3 in NTIS is the most sensitive independent predictor of short-term survival.Thyroid hormone concentrations may be used as prognostic indicators in elderly patients with non-thyroidal illness.