摘要
目的探讨老年危重症患者血清甲状腺激素水平的变化与急性生理学、慢性健康状况评分Ⅱ(APACHEⅡ)及其预后的关系。方法老年重症监护病房(GICU)中危重患者67例,依据APACHEⅡ评分将这些患者分为危重组(<16分,n=47)和极危重组(≥16分,n=20);同期住院的普通老年患者(非危重组)37例;门诊体检的健康老年人(正常对照组)34例。采用化学发光法测定上述各组的甲状腺激素水平。结果非危重组各项甲状腺激素水平与正常对照组比较差异无统计学意义(P>0.05);极危重组甲状腺素总量(TT4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平明显低于危重组及正常对照组,TT4(64.42±15.97)nmol/L vs(91.69±20.00)nmol/L、(98.05±21.04)nmol/L(P<0.01),FT3(1.52±0.52)pmol/L vs(2.33±0.75)pmol/L、(4.41±0.95)pmol/L(P<0.01),FT4(12.51±3.61)pmol/L vs(15.61±5.55)pmol/L、(16.64±2.19)pmol/L(P<0.01)。死亡组(n=17)三碘甲状腺原氨酸总量(TT3)、TT4、FT3和FT4水平明显低于存活组(n=50),TT3(0.60±0.22)nmol/L vs(0.78±0.28)nmol/L(P<0.05),TT4(63.25±16.75)nmol/L vs(90.39±20.13)nmol/L(P<0.01),FT3(1.47±0.52)pmol/L vs(2.30±0.75)pmol/L(P<0.01),FT4(12.13±3.71)pmol/L vs(15.48±5.42)pmol/L(P<0.05)。结论老年危重患者病情越重,甲状腺激素水平下降幅度越大,三碘甲状腺原氨酸、甲状腺素可用于评估老年患者的疾病严重程度和预后。
Objective To investigate the relationship between the changes of the serum thyroid hormone levels,the acute physiology and chronic health evaluation Ⅱ（APACHEⅡ） score,and the prognosis of the geriatric critical patients.Methods 67 geriatric critical patients in general intensive care unit（GICU） were divided into the severe group（16 scores,n=47） and the very severe group（≥16 scores,n=20） by APACHE Ⅱ score,and furthermore,37 common elderly inpatients（the uncritical group） and 34 healthy ones（the normal control group） who had undergone physical examination were enrolled in the study at the same time.Serum thyroid hormone concentrations of all the subjects were measured by chemiluminescent immunoassay.Results There were no significant differences in the levels of serum thyroid hormones between uncritical patients and the normal control group（P〉0.05）.The concentrations of serum total thyroxine（TT4）,free triiodothyronine（FT3）,free thyroxine（FT4） in the very severe patients were significantly lower than those in the severe group and the normal control group,TT4（64.42±15.97） nmol/L vs（91.69±20.00） nmol/L,（98.05±21.04） nmol/L（P〈0.01）;FT3（1.52±0.52） pmol/L vs（2.33±0.75） pmol/L,（4.41±0.95） pmol/L（P〈0.01）;FT4（12.51±3.61） pmol/L vs（15.61±5.55） pmol/L,（16.64±2.19） pmol/L（P〈0.01）,respectively.And the concentrations of serum total triiodothyronine（TT3）,TT4,FT3 and FT4 levels in the dead patients（n=17） were significantly lower than those in the survival ones（n=50）,TT3（0.60±0.22） nmol/L vs（0.78±0.28） nmol/L（P〈0.05）;TT4（63.25±16.75） nmol/L vs（90.39±20.13） nmol/L（P〈0.01）;FT3（1.47±0.52） pmol/L vs（2.30±0.75） pmol/L（P〈0.01）;FT4（12.13±3.74） pmol/L vs（15.48±5.42） pmol/L （P〈0.05）,respectively.Conclusion The more critical state of the elderly subjects,the more decreasing levels of thyroid hormones,therefore,the changes of T3 and T4 levels might be used to evaluate the extent and prognosis of severe disease.
出处
《临床荟萃》
CAS
2011年第3期212-214,共3页
Clinical Focus
关键词
危重病
甲状腺功能试验
预后
critical illness
thyroid function tests
prognosis
