肠外营养支持下胃肠道肿瘤患者围手术期甲状腺激素水平变化

目的观察肠外营养支持下胃肠道肿瘤患者围手术期甲状腺激素水平变化。方法行R0根治术的胃肠肿瘤患者36例作为肿瘤组。同期收入院的无甲状腺疾病的患者10例作为对照组。肿瘤组术前1天及术后第14天分别检测血清甲状腺激素（TH）。肿瘤组术后给予15～20 kCal/（kg.d）的肠外营养支持5～7 d,肠蠕动恢复后给予清流食并逐渐过度至流食、半流食。用微粒子捕捉酶免疫分析法检测血清FT3、TT3、FT4及TSH含量,荧光偏振免疫分析法检测血清TT4含量,放射免疫分析法检测血清rT3含量。结果肿瘤组术前FT3水平明显低于对照组（P〈0.05）,rT3水平明显高于对照组（P〈0.01）。肿瘤组术后第14天FT3、TT3明显低于术前水平（P〈0.05）。rT3明显高于术前水平（P〈0.01）。结论①胃肠肿瘤患者术前即已存在非甲状腺疾病综合征（nonthyroid illness syndrome,NTIS）;②胃肠肿瘤患者术后NTIS短期内很难完全恢复。

Level of Thyroid Hormone(TH) of Gastroenteric Tumor Patients During Peri-Operative Period

Objective To observe the level of thyroid hormone（TH） of gastroenteric tumor patients with parenteral nutrition support during peri-operative period.Methods TH concentration of 36 gastroenteric tumor patients were detected in preoperative and in the 14th day after operation.Tumor patients were treated by R0 resection as experiment group.In contrast,TH concentration of 10 control subjects was detected.The gastroenteric tumor patients were supported by parenteral nutrition（15-20 kcal/kg·d）.FT3,TT3,FT4 and TSH were detected by microparticle enzyme immunoassay（MEIA）,TT4 were tested by fluorescence polarization immunoassay（FPIA）,rT3 were examined by immunoradiometric assay.Results FT3 level of case group were significantly lower than that of control group（P0.05）,while rT3 was dramatically higher than that of control group（P0.01）.FT3 and TT3 level of 14 days after operation were significantly lower than that of preoperative（P0.05）,while rT3 was dramatically higher than that of preoperative（P0.01）.Conclusion ① NTIS has existed before the operation of gastroenteric tumor patients.②There is a slim chance for patients to completely recovery from NTIS post operation in a short period.