腹腔感染合并非甲状腺病态综合征危重症患者预后的影响因素

doi:10.3877/cma.j.issn.2095-655X.2015.04.017

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摘要目的探讨腹腔感染合并非甲状腺病态综合征（NTIS）危重症患者预后的影响因素。方法2014年1月至2015年1月入住中山大学附属第六医院重症医学科的74例腹腔感染患者，入重症监护室第1天测定血清游离三碘甲状腺原氨酸（FT3）、总三碘甲状腺原氨酸（TT3)、游离甲状腺素（FT4）、总甲状腺素（TT4）和促甲状腺激素（TSH）水平及 C-反应蛋白（CRP），白蛋白水平，前白蛋白水平。根据血清甲状腺激素水平将患者分为NTIS组和甲状腺功能正常组，比较两组患者在死亡率、住院时间、ICU停留时间、机械通气时间和住院花费之间的差别。结果在入组病例中，NTIS发生率为82.5%。NTIS组平均年龄［（69.6±7.8）岁］、急性生理与慢性健康（APACHE Ⅱ）评分［（16.2±3.3）分］高于甲状腺功能正常组［（59.1±5.4）岁，（11.1±1.4）分］，差异有统计学意义（t=1.99,1.98;P＜0.05）。NTIS组白蛋白水平［（26.7±4.2）g/L］低于甲状腺功能正常组［（31.1±2.3）g/L］，差异有统计学意义（t=1.979,P＜0.05）。NTIS组FT3［（3.02±0.04）pmol/L］、TT3［（0.92±0.03）pmol/L］、TT4［（82.20±1.14）pmol/L］水平低于甲状腺功能正常组［（4.49±0.05）pmol/L，（1.74±0.05）pmol/L，（95.70±3.47）pmol/L］，差异有统计学意义（t=2.65,2.64,2.65;P＜0.01）。NTIS组住院期间死亡率（3.28%）、住院时间［（31.00±6.00）d］、ICU停留时间［（9.00±3.00）d］、机械通气时间［（8.00±1.00）d］及住院花费［（14.37±2.41）万元］均高于甲状腺功能正常组［0，（17.00±7.00）d，（4.00±3.00）d，（3.00±1.00）d，（8.52±1.79）万元］，差异有统计学意义（χ2=0.30；t=2.65,2.60,2.70,2.66;P＜0.05）。多因素变量分析发现，APACHE Ⅱ评分与ICU停留时间存在相关关系［B=0.619，P<0.01］。结论NTIS是腹腔感染危重症患者中常见的一种并发症，腹腔感染危重症患者合并NTIS时，预示患者有较差的疾病转归及预后，但NTIS并不是引起机械通气时间及死亡率增加的独立危险因素；急性生理与慢性健康评分是机械通气时间及死亡率增加的独立危险因素。

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关键词 ：非甲状腺病态综合征, 腹腔感染, 危重病

Abstract：ObjectiveTo explore the impact factors of prognosis in critical patients with abdominal infection and nonthyroidal illness syndrome.MethodsSeventy-four abdominal infection patients admitted to intensive care unit (ICU) were enrolled in the Sixth Affiliated Hospital of Sun Yat-sen University,from January 2014 to January 2015.In the first day of ICU,free triiodothyronine (FT3),total triiodothyronine (TT3),free thyroxine (FT4),total thyroxine (TT4),thyroid stimulating hormone (TSH) and the levels of C-reactive protein (CRP),albumin，prealbumin were examined.The patients were divided into NTIS group and euthyroid group according to the level of the serum thyroid hormone.ResultsThe incidence of NTIS was 82.5% in our study.The levels of age(69.6±7.8) and APACHE Ⅱ scores(16.2±3.3) of NTIS group were significantly higher than those of euthyroid group ［ (59.1±5.4)， (11.1±1.4)，t=1.994,1.981;P<0.05］;the level of albumin (26.7±4.2) of NTIS group was significantly lower than that of euthyroid group ［ (31.1±2.3)，t=1.979,P<0.05］.The levels of FT3(3.02±0.04),TT3(0.92±0.03),TT4 (82.20±1.14) of NTIS group were significantly smaller than those of euthyroid group ［ (4.49±0.05)，(1.74±0.05)，(95.70±3.47)，t=2.65,2.64,2.65;P<0.01］,but the mortality in the hospital（3.28%）,hospitalization time(31.00±6.00),the length of ICU stay(9.00±3.00),ventilation time(8.00±1.00) and hospitalization expenses （14.37±2.41） in NTIS group were significantly greater than those in euthyroid group［0,(17.00±7.00),(4.00±3.00),(3.00±1.00),(8.52±1.79),χ2=3.30,t=2.65,2.60,2.70,2.66;P<0.05］.Using multivariate analysis of variance,the study found the APACHE Ⅱ score was veried as risk factor for mechanical ventilation and mortality.ConclusionsNTIS is a common complication in critical patients with abdominal infection.Abdominal infection in critical patients with NTIS is associated with poor outcome and prognosis,but NTIS is not the risk factor for mechanical ventilation mortality in the critical ill patients.The APACHE Ⅱ score is varied as risk factor for mechanical ventilation and mortality.

Key words： Nonthyroidal illness syndrome Abdominal infection Critical illness

收稿日期: 2015-08-15

通讯作者: 冠秋野，Email：kouqiuye@126.com

引用本文:

刘恩贺王丽纯陈雷郑志楠胡文利寇秋野. 腹腔感染合并非甲状腺病态综合征危重症患者预后的影响因素[J]. 中华诊断学电子杂志, 2015, 3(4): 288-.
Liu Enhe1,Wang Lichun1,Chen Lei1,Zheng Zhinan2,Hu Wenli1,Kou Qiuye1. The impact factors of prognosis in critical patients with abdominal infection and nonthyroidal illness syndrome. zhzdx, 2015, 3(4): 288-.

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http://www.zhzdxzz.com/CN/10.3877/cma.j.issn.2095-655X.2015.04.017 或 http://www.zhzdxzz.com/CN/Y2015/V3/I4/288