摘要
背景急诊住院患者病情复杂,甲状腺激素(thyroid hormone,TH)是评判急诊患者机体状况的代谢指标,而作为重要的TH指标,三碘甲状腺原氨酸(triiodothyronine,T3)与急诊住院患者病情程度的关系仍不清楚。目的探讨T3与非内分泌科急诊住院患者病情程度及相关指标的相关性。方法回顾性纳入2021年1—6月于南京中医药大学附属中西医结合医院急诊病区行TH检测的患者资料,根据TH水平,将其分为非甲状腺性病态综合征(nonthyroidal illness syndrome,NTIS)组和非NTIS组,分析各组的临床特征及其TH水平;并根据临床诊断对住院患者分为3组,即感染组、非感染组及脏器功能受损组,其中感染组又分为脓毒症组、肺部感染组和局部感染组,评价各组的TH水平及低值情况(任一激素低于参考值),并探讨TH激素水平与急诊住院患者死亡风险的关系。结果共纳入175例患者,男性108例,女性67例,平均年龄(66.12±16.23)岁。NTIS的发生率达62.29,其中低T3发生率最高(56.00%),其次为FT3(46.86%)。NTIS组的病死率高于非NTIS组(28.44%vs 10.61%,P=0.006)。脓毒症组和脏器功能受损组并发NTIS的比率最高,分别达83.33%和78.12%,非感染组仅23.52%。ROC曲线分析表明,单独检测T3对死亡风险的预测能力较强(AUC=0.750,95%CI:0.673~0.828,P<0.001)。结论T3是急诊住院患者病情判断的最敏感指标,其次为FT3,T3对死亡风险具有一定的预测价值,急诊危重患者应注意监测甲状腺功能。
Background Thyroid hormone(TH)is a metabolic indicator for judging the physical condition of emergency hospitalized patients,the relationship between triiodothyronine(T3)and the condition degree of emergency inpatients remains unclear.Objective To explore the correlation between T3 and the severity of condition and corresponding indicators in nonendocrinology emergency inpatients.Methods Clinical data about TH detected patients in emergency wards of Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine from January to June in 2021 were retrospectively included,then the patients were divided into NTIS group and non-NTIS group according to TH levels,and the hematological characteristics and TH levels of each group were analyzed.According to clinical diagnosis,the hospitalized patients were divided into infection group,non-infection group and impaired organ function group,in which the infection group was further divided into sepsis group,lung infection group,and local infection group.The thyroid function levels and low values in each group were evaluated,and the relationship between TH hormone levels with the risk of death of emergency inpatients was discussed.Results A total of 175 patients were enrolled,including 108 males and 67 females,with a mean age of(66.12±16.23)years.The incidence of NTIS in emergency ward was 62.29%,and T3 was the most sensitive indicator(56.00%),followed by FT3(46.86%).The risk of death in NTIS group was higher than that of non-NTIS group(28.44%vs 10.61%,P=0.006).The incidence of NTIS was high in sepsis group(83.33%)and organ dysfunction group(78.12%),and only 23.52%in non-infection group.The Receiver Operating Curve(ROC)and Area under the curve(AUC)showed T3 level was highly associated with the risk of death(AUC:0.750;95%CI:0.673-0.828;P<0.001).Conclusion T3 is the most sensitive index for emergency patients,followed by FT3,and the decrease of T3 level has a certain predictive value for the risk of death.Thyroid function should be monitored in critically ill patients.
作者
孙丹群
冯仁余
徐书杭
王书侠
SUN Danqun;FENG Renyu;XU Shuhang;WANG Shuxia(Clinical Laboratory,Jiangbei Branch of Zhongda Hospital Affiliated to Southeast University,Nanjing 210044,Jiangsu Province,China;Emergency Department,Jiangsu Province Academy of Traditional Chinese Medicine,Nanjing 210028,Jiangsu Province,China;Research Center of Endocrine and Metabolic Diseases,Jiangsu Province Academy of Traditional Chinese Medicine,Nanjing 210028,Jiangsu Province,China;Clinical Laboratory,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine,Jiangsu Province Academy of Traditional Chinese Medicine,Nanjing 210028,Jiangsu Province,China)
出处
《解放军医学院学报》
CAS
2024年第5期481-485,共5页
Academic Journal of Chinese PLA Medical School
基金
江苏省重点研发计划(BE2020726)。
