摘要
目的 :探讨急性生理学与慢性健康状况评分 (APACHE )与甲状腺激素水平及疾病严重程度和预后的关系。方法 :对 4 3例 ICU患者的甲状腺激素〔总三碘甲状腺原氨酸 (TT3)、总甲状腺素 (TT4 )、游离三碘甲状腺原氨酸 (FT3)、游离甲状腺素 (FT4 )〕和促甲状腺激素 (TSH )水平与疾病严重程度及预后进行相关分析。疾病严重度采用入 ICU第 1个 2 4小时收集的 APACHE 评分 ,分为 4组 (轻度组 <6 0分 ,中度组 6 1～ 90分 ,重度组 91～ 12 0分 ,特重度组 >12 1分 ) ,同时取血查甲状腺激素。根据出院情况分为生存组与死亡组 ,比较 2组的甲状腺激素水平。结果 :APACHE 评分与 TT3、TT4 、TSH均呈负相关 (分别为 r1 =0 .6 0 7,P<0 .0 1;r2 =0 .4 34,P<0 .0 1;r3=0 .336 ,P<0 .0 5 )。TT3轻度组与中度、重度、特重度组及中度组与特重度组比较均有显著差异 (P均 <0 .0 5 ) ,TT4 轻度组与中度、重度、特重度组比较均有显著差异 (P均 <0 .0 5 )。死亡组 TT3、TT4 、TSH均较生存组降低 ,TT3、TSH下降幅度显著 (P均 <0 .0 1)。结论 :危重病患者病情越重 ,APACHE 评分越高 ,甲状腺激素水平下降幅度越大。TT3可作为评价 ICU患者预后的指标 ,APACHE 评分与甲状腺激素下降程度相关 ;两者结合用于临床 ,对危重病患者病情严重度判?
Objective:To compare the relationship of the prognosis and the critical degree of disease with acute physiology and chronic health evaluation Ⅲ(APACHE Ⅲ) score and levels of thyroid hormone.Method:The prognosis and the critical degree of disease and the levels of thyroid hormone in 43 ICU,patients were studied prospectively.According to the APACHEⅢ score that collected from the patients in the first 24 hours in ICU patients were divided into 4 groups (the scores for the mildly serious group were<60,moderately serious group 6190,serious group 91120,critically serious group >121).At the same time,thyroid hormone levels in the blood were measured to look for the correlation.Patients were also divided into survivor group and nonsurviv or group,and the thyroid hormone levels were compared between two groups.Results:APACHEⅢ score were negatively correlated with triiodothyronine(TT 3),tetraiodothyronine(TT 4) and thyroidstimulating hormone(TSH, r 1=0 607, P <0 01; r 2=0 434, P <0 01; r 3=0 336, P <0 05,respectively).There were differences in TT 3 comparing the mildly serious group with moderate,serious and critically,serious group (all P <0 05).When compared with the survivor group ( n =33),the TT 3,TT 4,TSH levels were all lower in nonsurvivor group ( n =10),and lowering of TT 3 and TSH was statistically significant (both P <0 01). Conclusions :The more serious condition patients are,the more thyroid hormone is decreased.TT 3 can be an index to predict the prognosis of ICU patients.APACHEⅢ score is correlated with the lowering of level of thyroid hormone.It would be more accurate to evaluate the prognosis and to assess the degree of seriousness of patients′ condition if both APACHEⅢ scoring and determination of thyroid hormone levels are used.
出处
《中国危重病急救医学》
CAS
CSCD
2002年第5期300-302,共3页
Chinese Critical Care Medicine
基金
广东省韶关市医药卫生科研计划资助项目 (No.9912 )
关键词
急性生理学
慢性健康状况评分Ⅲ
甲状腺激素
重危患者
预后
acute physiology and chronic health evaluation Ⅲ score
thyroid hormone
serious patients
prognosis
