|其他题名||Relationship between thyroid hormone level and the change of left ventricular function in septic patients
|王斌; 郭治国; 葛庆岗; 郑亚安
|摘要||目的 探讨脓毒症患者甲状腺功能紊乱的发生情况及其与左心室结构、功能变化的关系.方法 入选63例脓毒症患者,入院次日测定血清甲状腺激素和C反应蛋白(CRP)水平,记录患者入院时年龄、性别、疾病、APACHEⅡ评分和后期发生休克及多器官功能障碍综合征(MODS)等一般资料,并在入院24h、第2周、第3周动态观察左心室结构及功能的变化.另选择一般感染组患者(38例)作对照组,比较脓毒症组与对照组甲状腺功能的差别以及早期血清甲状腺激素水平在脓毒症患者不同严重程度的心脏结构及功能改变间的差异性.结果 脓毒症患者血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺(FT4)水平均明显低于一般感染组(P＜0.05);而促甲状腺素(TSH)无显著变化(P＞0.05),其左心室变化表现为:左心室舒张功能减低(Ⅰ型)31例,左心室扩大和左心室舒张功能减低(Ⅱ型)18例,左心室扩大、左心室收缩和舒张功能减低(Ⅲ型)14例;与Ⅰ、Ⅱ型比较,Ⅲ型患者血清Fr3、FT4水平显著降低,休克及MODS发生率显著升高而Ⅰ、Ⅱ型患者间上述指标差异均无统计学意义.结论 脓毒症患者普遍存在甲状腺功能紊乱,早期血清甲状腺激素水平对疾病后期左心室结构和功能病变具有一定预测作用.
Objective To investigate the occurrence of thyroid disorders in septic patients and the relationship between thyroid hormone level and the change of left ventricular function.Methods A total of 63 septic patients,43 male and 20 female,aged 50 to 88 years with mean 63.3 ± 18.5,were included in the present study.The thyroid hormone levels and C-reactive protein (CRP) levels were detected in all patients on the next day of admission.Clinical information of each patient was recorded including demographics and co-existed disease,APACHE Ⅱ score at admission and the incidence of shock and subsequent multiple organ dysfunction syndrome (MODS).At 24 hours,the second week and the third week after admission,a serial trans-thoracic echocardiography were performed in all patients to observe changes of left ventricular end diastolic dimension,left ventricular eject fraction and E/A (the ratio between maximal velocity of blood flow at mitral valve orifice in the early diastolic phase and maximal velocity of blood flow of atrium in systolic phase).Another 38 patients with ordinary infections,21 male and 17 female,with mean age 58.6 ± 16.8 (48-84 years) were selected as controls for comparison.The difference in thyroid function between sepsis group and control group was analyzed.The levels of serum thyroid hormone associated with the incidence of shock and MODS were studied among different types of the left ventricular structure and function in sepsis group.Results The levels of serum free tri-iodothyronine (FT3) and free tetra-iodothyronine (FT4) in sepsis group were significantly lower than those in control group (P ＜ 0.05),but there was no difference in level of thyroid stimulating hormone (TSH) between these two groups.The patients with sepsis had three types of the left ventricular dysfunction:diastolic dysfunction without the enlargement of left ventricular (type Ⅰ) in 31 patients,the enlargement of left ventricular with diastolic dysfunction (type Ⅱ) in 18 patients and the enlargement of left ventricular with both systolic and diastolic dysfunction (type Ⅲ) in 14 patients.Compared with the other two types,the type Ⅲ patients had significantly lower levels of FT3 and FT4 and higher incidences of shock and MODS (P ＜ 0.05).No significant difference in TSH level was found among the three types.There were no significantly differences in FT3 and FT4 between type Ⅰ and type Ⅱ,but the higher incidences of shock and MODS were found in type Ⅰ (P ＞ 0.05).Conclusions Most septic patients have thyroid function disorder.Serum thyroid hormone levels in early stage of sepsis have certain role in predicting changes in left ventricular structure and function in the late stage of disease.|
王斌,郭治国,葛庆岗,等. 脓毒症患者甲状腺功能与左心室功能改变相关性研究[J]. 中华急诊医学杂志,2014,23(1):61-64.
王斌,et al."脓毒症患者甲状腺功能与左心室功能改变相关性研究".中华急诊医学杂志 23.1(2014):61-64.
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