非甲状腺疾病综合征机械通气患者血浆基线促甲状腺激素水平对预后的预测价值  

Predictive value of plasma baseline thyrotropin levels in nonthyroid illness syndrome patients with mechanical ventilation

作　　者：刘平[1] 臧学峰[1] 甄洁[1] 朱曦[2] 陈炜[1] 

机构地区：[1]首都医科大学附属北京世纪坛医院重症医学科,北京100038 [2]北京大学第三医院重症医学科,北京100191

出　　处：《中国医药导报》2017年第18期68-71,75,共5页China Medical Herald

基　　金：国家自然科学基金面上项目(81372043)

摘　　要：目的分析住院期间非甲状腺疾病综合征(NTIS)机械通气患者血浆基线促甲状腺激素(TSH)水平对预后的预测价值。方法连续入选2015年1月~2016年8月在北京世纪坛医院ICU住院期间行气管插管机械通气且既往无甲状腺疾病患者共188例,根据甲状腺功能分为合并NTIS组156例和不合并NTIS组32例,总结NTIS的发病率及临床特点。其中又将合并NTIS的156例患者,根据T3、T4水平分为低T3综合征和低T4综合征两个亚组,根据TSH水平分为<0.27 mIU/L、0.27~<2.50 mIU/L、2.50~<4.50 mIU/L三个亚组,对比各组临床资料及预后。结果 NTIS的发病率为83%。合并NTIS组的PCT、CRP高于不合并NTIS组,ALB及Ca^(2+)低于不合并NTIS组(P<0.05)。低T4综合征组ALB、Ca^(2+)及Hb均较低T3综合征组低(P<0.05)。TSH 2.50~<4.50 mIU/L组T3水平最低,TSH 0.27~<2.50 mIU/L组患者机械通气时间最短(P<0.05)。COX生存分析提示,TSH 2.50~<4.50 mIU/L是14 d预后良好的独立预测因素(P<0.05),不同水平TSH组30 d预后比较差异无统计学意义(P>0.05)。结论对于合并NTIS的机械通气患者,TSH 2.50~<4.50 mIU/L是14 d预后良好的独立预测因素。Objective To analyze predictive value of plasma baseline thyrotropin levels in nonthyroid illness syndrome（NTIS） patients with mechanical ventilation during hospitalization. Methods From January 2015 to August 2016, 188 patients received incubation and had no history of thyroid illness in ICU of Beijing Shijitan Hospital were continuously enrolled. All patients were divided into NTIS group of 156 cases and without NTIS group of 32 cases according to thyroid function. The morbidity and clinical characters of NTIS patients were summarized. 156 patients with NTIS were divided into two subgroups of low T3 syndrome and low T4 syndrome according to T3 and T4 levels. 156 patients with NTIS were divided into three subgroups of 〈0.27 mIU/L, 0.27-〈2.50 mIU/L, 2.50-〈4.50 mIU/L according to TSH level.Clinical data and prognosis of each group were compared. Results The morbidity of NTIS was 83%. The levels of PCT and CRP in NTIS group were higher than those in without NTIS group, while the levels of ALB and Ca^2＋ were lower than those in without NTIS group（P〈0.05）. The levels of ALB, Ca-（2＋）and Hb in low T4 syndrome group were lower than those in low T3 syndrome group（P〈0.05）. TSH 2.50-〈4.50 mIU/L group had the lowest T3 level, TSH 0.27-〈2.50 mIU/L group had the shortest mechanical ventilation time（P〈0.05）. COX survival analysis showed that TSH 2.50-〈4.50 mIU/L was an independent predictor of good prognosis for 14 days（P〈0.05）. There was no significant difference in prognosis between different levels of TSH group（P〈0.05）. Conclusion For patients with mechanical ventilation with NTIS, TSH2.50-4.50 mIU/L is an independent predictor of good prognosis for 14 days.

关 键 词：机械通气 非甲状腺疾病综合征 促甲状腺激素 预后 

分 类 号：R581[医药卫生—内分泌]