低T3综合征对重度急性一氧化碳中毒迟发性脑病的预测价值  

The predictive value of low T3 syndrome for delayed encephalopathy caused by severe acute carbon monoxide poisoning

作　　者：刘永建[1] 徐文嫔 王岩[1] 王维展[1] Liu Yongjian;Xu Wenpin;Wang Yan;Wang Weizhan(Department of Emergency Medicine,Harrison International Peace Hospital Affiliated to Hebei Medical University,Hengshui 053000,China)

机构地区：[1]河北医科大学哈励逊国际和平医院急救医学部,衡水053000

出　　处：《中华劳动卫生职业病杂志》2021年第10期744-747,共4页Chinese Journal of Industrial Hygiene and Occupational Diseases

基　　金：河北省卫健委医学科学研究课题(20200405)。

摘　　要：目的探讨低T3综合征(LT3S)对急性一氧化碳中毒迟发性脑病(DEACMP)的预测价值。方法于2020年5月,选择河北医科大学哈励逊国际和平医院2019年1月至2020年1月收治的137例重度急性一氧化碳中毒(SACMP)患者作为研究对象。所有患者入院采血化验甲状腺功能。随访60 d,根据患者预后分为DEACMP组(45例)和非DEACMP组(92例)。收集并比较患者的一般资料,用多自变量Cox回归分析DEACMP的独立危险因素。用Pearson相关分析法评价总三碘甲状腺原氨酸(TT3)水平与急性生理与慢性健康Ⅱ(APACHE Ⅱ)评分的相关性。绘制受试者工作特征(ROC)曲线分析TT3、APACHE Ⅱ评分对DEACMP的预测价值。结果与非DEACMP组比较,DEACMP组患者的年龄、APACHE Ⅱ评分、LT3S发生率和糖尿病患病率较高,格拉斯哥昏迷(GCS)评分较低,差异均有统计学意义(P<0.05);Cox回归分析显示,年龄、APACHEⅡ评分和发生LT3S是SACMP患者发生DEACMP的独立危险因素(OR=1.040,95%CI:1.005~1.077;OR=1.070,95%CI:1.002~1.143;OR=4.210,95%CI:1.707~10.379;P<0.05);Pearson相关性分析发现,TT3水平与APACHE Ⅱ评分呈负相关(r=-0.397,P=0.000)。TT3对DEACMP预测的截断值为1.078 nmol/L,曲线下面积(AUC)为0.755,敏感度为82.6%,特异度为73.3%;APACHE Ⅱ评分预测DEACMP的截断值为16分,AUC为0.725,敏感度为93.3%,特异度为60.9%。结论 LT3S可能是SACMP患者发生DEACMP的预测指标,甲状腺功能与SACMP患者危重度密切相关。Objective To explore the predictive value of low T3 syndrome(LT3S)for patients with delayed encephalopathy after acute carbon monoxide poisoning(DEACMP).Methods In May 2020,137 severe acute carben monoxide poisoning(SACMP)patients were selected from Harrison International Peace Hospital Affiliated to Hebei Medical University from January 2019 to January 2020 as subjects.Blood samples were taken after admission to test thyroid function.Followed up for 60 d,the patients were divided into DEACMP group(45 cases)and non DEACMP group(92 cases)according to their prognosis.Clinical data of patients in two groups were collected and compared.The Cox regression with multiple independent variables was used to analyze the independent risk factors of DEACMP.Pearson correlation analysis was used to evaluate the correlation between totall triiodochyronine(TT3)level and Acute Physiology and Chronic Health Evaluation(APACHE)Ⅱscore.The receiver operating characteristic(ROC)curve of TT3 and APACHEⅡscores for predicting DEACMP were drawn.Results Compared with non DEACMP group,the age,APACHE II score,LT3S rate and diabetes prevalence in DEACMP group were higher,and the Glasgow coma scale(GCS)score was lower(P<0.05).Cox regression analysis showed that age,APACHEⅡscore and LT3S were independent risk factors of DEACMP in patients with SACMP(OR=1.040,95%CI:1.005-1.077;OR=1.070,95%CI:1.002-1.143;OR=4.210,95%CI:1.707-10.379;P<0.05).Pearson correlation analysis showed that TT3 level was negatively correlated with APACHEⅡscore(r=-0.397,P=0.000).ROC curve showed that the cut-off value of TT3 level for DEACMP prediction was 1.078 nmol/L,the area under curve(AUC)was 0.755,the sensitivity was 82.6%,and the specificity was 73.3%.The cut-off value of the APACHEⅡscore for predicting DEACMP was 16,and the AUC was 0.725,sensitivity was 93.3%,and specificity was 60.9%.Conclusion This study showed that LT3S minght be an independent predictor of DEACMP in patients with SACMP.Thyroid function is closely related to the severity of SACMP patients.

关 键 词：三碘甲状腺原氨酸 甲状腺激素 一氧化碳中毒 重度 迟发性脑病 低T3综合征 预测 

分 类 号：R595.1[医药卫生—内科学]