颅脑外伤病人甲状腺激素水平与疾病严重程度及预后的关系

目的研究颅脑外伤病人甲状腺激素水平与疾病严重程度及预后的关系。方法对例颅脑外伤病人的甲状腺激素水平与疾病的严重程度及预后的关系进行前瞻性研究。疾病的严重程度及预后分别采用GCS和GOS评分。入院第二天抽血查血清甲状腺激素（TT3、FT3、TT4、FT4、rT3和TSH）的浓度。结果GCS评分与TT3（r＝0．4630，P＜0．001）、FT3（r＝0．442，P＜0．01）和TT4（r＝0．2994，P＜0．05）的水平相关，与FT4和rT3无明显相关性。根据GCS评分结果分三组：①重度组（n＝12）：GCS3～8分；②中度组（n＝11）：GCS9～12分；③轻度组（n＝24）：GCS13～15分。三组的TT3（P＜0．01）和FT3（P＜0．01）值有差别，其中重度组和中度组的TT3和FT3水平分别比轻度组降低33．3％～35．5％和33．3％～34．7％。GOS评分与TT3（r＝0．5756，P＜0．001）、FT3（r＝0．5017，P＜0．001）和TT4（r＝0．3984，P＜0．01）的水平相关，与FT4、rT3和TSH无明显相关性。根据GOS评分结果分三组：①A组（n＝8）：死亡组；②B组（n＝16）：持续植物人状态和重度残废组；③C组（n＝23）：轻度残废和恢复良好组。三组的TT3（P＜0．001）和FT3（P＜0．01）值有差别，其中A组和B组的TT3和FT3水平分别比C组降低36．4％～45．0％和31．5％～40．3％

Correlation of thyroid hormones concentrations with the severity of the illness and the prognosis in traumatic brain injury

Objective To study the correlation of thyroid hormones concentratiions with the severity of the illness and the illness and the prognsis in traumatic brain injury . Methods Forty -seven traumatically braininjured patients had serum thyroid hormones (total and free triiodothyronine ,total and free thyroxine , reverse triiodothyronine and thyrotropin) concentrations measured on the second day of admission to assess whether thyroidfunction tests could correlate with the sveerity of the illness and the prognosis . Severity of neurologic derangement was determined using the Glasgow Coma Scale (GCS). Ultimate patient outcome at the time of discharge from the hospital was determined using the Glasgow Outcome Scale (GOS).Results Significant correlations were present ebtween GCSand total triiodothyronine (r = 0.4630, P < 0.001 ), free thiiodothyronine (r =0.4427 ,P< 0.01), and total thyroxine (r = 0.2994, P < 0.05) levels. There was no association between GCS and free thyroxine or revere triiodothyronine . The patients were divided into the following groups on the basis of the basis of the ddegree of neurologic dysfunction ; (1 )severs group (n = 12):GCS 3 to 8;(2)moderate group (n= 11 ): GCS 9 to 12; (3) mild group (n = 24): GCS 13 to 15. Signufucabt dufferebces ub bitg titak abd free triiodothyronine (P < 0.01 )were present across the three groups . Patients in severe and moderate group had tota of free triiodothyronine levels 33.3% ~ 35.5% or 33.3% ~ 34.7% lower than those in mild group respectively .Significant correlations were present between COS and total triildothyronine (r = 0.5756, P < 0.001 ), the triiodothyronine (r = 0.5017, P < 0.001 ), and total thyroxine (r = 0. 3984, P < 0.01 )levels. Therewas no association between COS and free thyroxine ,revere triiodothyronine or thyrotropin . The patients were divided into the following groups according to GOS: (1)group A(n = 8):death ; (2)group B(n = 16): persistent vegetative state and severe disability ; (3)group C(n = 23):moderate disability and good recovery . Significant differences inj total triiodothyronine (P < 0.001 ) and free triiodothyronine (P < 0.01 ) werepresent across the three groups . Patients in group A and B had total or free triiodothyronine levels 36.4% ~ 45.0% or 31 .5% ~ 40.3% lower thanthose in group C.Conclusion Serum concentrations of tota triiodothyronine ,free triiodothyronine and total thyroxine in traumatic in traunmatic brain are correlated with the severity of the illness , and reflect ultimate outcome .