危重症患儿甲状腺激素水平与炎症指标的相关性及对预后的预测价值  

The correlation between thyroid hormone levels and inflammatory markers in critically ill children and their predictive value for prognosis

作　　者：曲艳凝 刘霜[2] 张瑾[2] 戈海延 曲东[2] 郭琳瑛[1] 任晓旭[2] Qu Yanning;Liu Shuang;Zhang Jin;Ge Haiyan;Qu Dong;Guo Linying;Ren Xiaoxu(Emergency Department,Capital Pediatric Institute Affiliated Children's Hospital,Beijing 100020,China;Department of Intensive Care Unit,Capital Pediatric Institute Affiliated Children's Hospital,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院急诊科,北京100020 [2]首都儿科研究所附属儿童医院重症医学科,北京100020

出　　处：《中国小儿急救医学》2025年第2期116-121,共6页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨危重患儿甲状腺激素水平与炎症标志物的变化,分析其与疾病严重程度的相关性及其对预后的潜在影响,为危重症疾病的临床管理及评估预后提供参考依据。方法采用回顾性研究方法,对2019至2023年首都儿科研究所附属儿童医院重症监护室收治的394例患儿进行分析。按小儿危重病例评分将患儿分为3组,评分≤70分为极危重组81例,71~80分为危重组150例,>80分为非危重组163例。收集甲状腺功能指标和炎症标志物[C-反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子(TNF)-α、白细胞介素(IL)等]指标,并收集临床资料及预后情况,分析甲状腺功能指标与炎症标志物的相关性,并识别甲状腺功能、炎症标志物在预测重症患儿预后方面的价值。结果394例患儿中,发生非甲状腺疾病综合征321例,总发生率为81.5%,且随病情严重程度增加而升高。甲状腺激素[总三碘甲腺原氨酸(TT3)、游离三碘甲腺原氨酸(FT3)、总四碘甲状腺原氨酸(TT4)]水平在极危重组显著低于其他组(P<0.05)。炎症标志物CRP、PCT、TNF-α、IL-6、IL-8、IL-10在极危重组显著高于其他组(P<0.05)。甲状腺激素与炎症标志物呈负相关,受试者工作特征曲线分析表明TT3、FT3、IL-6和IL-8水平能有效预测疾病预后。在Logistic回归模型分析中,单变量回归模型显示TT3、FT3、TT4、PCT、IL-8、IL-10与疾病预后有显著关联。多变量Logistic回归模型显示IL-6和IL-8为预测疾病预后的独立因素。结论甲状腺激素水平的显著下降与疾病的严重程度和不良预后密切相关,炎症标志物的变化反映了疾病的炎症状态和严重性,并影响疾病预后。监测甲状腺功能及炎症状态在临床管理中十分重要,为危重症患儿的预后评估和治疗策略提供了新的视角。Objective To investigate the changes in thyroid hormone levels and inflammatory markers in critically ill children,analyze their correlation with disease severity,and explore their potential impact on prognosis,providing references for clinical management and prognosis assessment in critical illness.Methods A retrospective cohort study was conducted involving 394 pediatric patients admitted to the ICU of the Capital Pediatric Institute Affiliated Children's Hospital from 2019 to 2023.Based on the pediatric critical illness score,patients were divided into three groups:the extremely critical group(score≤70,n=81),the critical group(score 71–80,n=150),and the non-critical group(score>80,n=163).Data collected included thyroid function indicators,inflammatory markers[C-reactive protein(CRP),procalcitonin(PCT),tumor necrosis factor(TNF)-α,interleukin(IL),etc.],clinical information,and outcomes.The correlation between thyroid function indicators and inflammatory markers were analyzed.The predictive value of thyroid function indicators and inflammatory markers for prognosis in critically ill pediatric patients was assessed.Results Of the 394 children,non-thyroidal disease syndrome occurred in 321 cases,with an overall incidence of 81.5%,which increased with disease severity.Thyroid hormone[total triiodothyronine(TT3),free triiodothyronine(FT3),and total tetraiodothyronine(TT4)]levels were significantly lower in the extremely critical group than in the other groups(P<0.05).Inflammatory markers such as CRP,PCT,TNF-α,IL-6,IL-8,and IL-10 were significantly higher in the extremely critical group than in the other groups(P<0.05).Thyroid hormones were negatively correlated with inflammatory markers,and the receivor operating characteristic curves analysis indicated that TT3,FT3,IL-6 and IL-8 levels,could effectively differentiate disease prognosis.Univariate regression model showed significant associations between TT3,FT3,TT4,PCT,IL-8,and IL-10 and disease prognosis.The multivariate Logistic regression model showed IL-6 a

关 键 词：危重症 甲状腺激素 炎症标志物 细胞因子 预后 儿童 

分 类 号：R73[医药卫生—肿瘤]