非甲状腺疾病危重病人甲状腺功能异常综合征探讨

目的:观察危重病患者血清甲状腺激素(TH)的改变,并探讨其在危重病人病情转归和预后中的临床意义.方法:①测定无甲状腺疾病病史的危重病组和普通病组的血清甲状腺激素(TT3、TT4、FT3、FT4、TSH)的水平,并进行比较.②比较危重病组中存活患者和死亡患者之间TH水平变化.③比较存活的危重病人在急性期和缓解期的TH水平变化.结果:危重病组TT3、TT4、FT3均明显低于普通病组(P＜0.01),FT4轻度下降,但差异无显著性(P＞0.05),TSH水平两组比较差异无显著性(P＞0.05);危重病组中死亡病人TT3、TT4、FT3、FT4水平明显低于存活病人(P＜0.01),TT4降低尤为明显(P＜0.001);经过原发病治疗后,存活的危重病人血清甲状腺激素各项指标异常在缓解期均恢复正常水平,和急性期相比有显著性差异(P＜0.01).结论危重病人血清甲状腺激素水平的变化对评估病情转归及预后有一定的临床参考价值.

Euthyroid Sick Syndrome in Critical Non-thyroidal Patients

Objective:To observe the changes in serum thyroid hormone(TH) in critical non-thyroidal patients and investigate the clinical significance of TH level as a predictor of outcomes and prognosis in these patients.Methods: The serum thyroid hormone(TT3,TT4,FT3,FT4and TSH)levels were measured in non-thyroidal patients and compared:(1) between critical and non-critical patients;(2) between survivors and death cases of the critical group;and(3) between acute stage and convalescence in survivors of the critical group.Results: compared with non-critical patients,the serum TT3,TT4,FT3 levels in critical patients were dramatically lowered(P<0.01),the serum FT4 was insignificantly reduced(P>0.05) and TSH level showed no difference(P>0.05).Among critical patients,the serum TT3,TT4,FT3 and FT4 levels in death cases were significantly lower than those in survivors(P<0.01),particularly with regard to TT4(P<0.001).After being treated for primary conditions,those who survived showed recovery of TH levels during convalescence in contrast to acute stage(P<0.01).Conclusion: changes in thyroid hormones level may be helpful for evaluating the outcomes and prognosis in critical patients.