内科危重病患者血清甲状腺激素水平的监测及预后评估

目的探讨危重患者甲状腺功能的变化。方法186例内科危重住院患者作为观察组,同期健康体检者186例作为对照组,观察正常甲状腺病态综合征(euthyroid sick syndrome,ESS)发生情况,对比观察组与对照组、观察组中存活组与病死组治疗前后甲状腺激素检查结果,ESS者治疗前后甲状腺激素检查结果,ESS与死亡的关系。结果186例内科危重病患者中发生ESS78例,发生率41.93%(78/186);观察组入院时TT3、FT3低于对照组,TT4、FT4、TSH两组比较无显著性差异(P>0.05);观察组中存活组和病死组比较TSH无显著性差异外、病死组TT3、FT3、TT4、FT4均低于存活组(P<0.05);原发病治疗好转后,甲状腺激素可恢复或接近正常;发生ESS病死率30.77%高于未发生变化的病死率13.9%。结论血清甲状腺激素水平的变化反映了危重住院患者的全身状态和严重程度,动态检测血清中甲状腺激素水平可以观察肺心病的发展和转归。

Relationship between Acute Physiology and Chronic Health Evaluation and Levels of Thyroid Hormone in Serious Patients

Objective To explore variations in the functions of thyroid of the patients with mortal disease. Methods The patients with mortal disease of 186 cases as the observation group, in the same period 186 cases of healthy control group, Observation euthyroid sick syndrome （euthyroid sick syndrome, ESS） occurred, compared to observe and control groups,Observer Group in the survival group died with the group, ESS thyroid hormone treatment before and after the test results, ESS and death. Results The patients with mortal disease of ESS incidence of 41.93%（78/186）; Section observe the admission T3, FT3 lower than the control group; Observer Group in the survival group died and TSH group no significant difference, the group died T3, FT3, T4, FT4 were lower than the survival group （P〈 0.05）; improvement in the treatment of primary disease, thyroid hormone, or return to near normal; ESS mortality occurred in 30.77% higher than a change of 13.9% mortality rate.Conclusion Serum thyroid hormone levels to reflect changes in the patients with mortal disease of the state of the body and severity of the dynamic serum levels of thyroid hormone can observe the development of pulmonary heart disease and prognosis.