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目的探讨危重症患者血清甲状腺激素、皮质醇的变化规律,与病情的关系及其临床意义。方法应用化学发光法测定51例患者入ICU后第1天及2天后仍存活的45例患者第3天的血清甲状腺激素、促甲状腺激素和皮质醇(COR)的水平。入ICU后2 d存活的45例患者中,17例伴有多器官功能障碍综合征(MODS组),28例不伴MODS(非MODS组)。在入ICU第1天记录所有患者的年龄、血糖和APACHEⅡ评分。结果存活的45例患者中41例(91％)血清FT3水平下降,33例(73％)血清皮质醇水平升高,在疾病最初的24 h更加明显。MODS组各项指标比非MODS组变化显著。6例死亡患者血清FT4下降明显。血清FT3水平与APACHEⅡ呈负相关,COR水平与APACHEⅡ呈正相关。结论危重症患者血清甲状腺激素和皮质醇水平与疾病的严重程度相关, MODS组各激素变化比非MODS组显著;血清FT4的下降程度与病情危重程度一致,可能作为判断预后的指标。
Objective To investigate the changes of serum thyroid hormones and cortisol in critically ill patients and its relationship with the disease and its clinical significance. Methods Serum levels of thyroid hormones, thyroid stimulating hormone and cortisol (COR) were measured on day 3 in 45 patients who survived on day 1 and 2 days after 51 patients were admitted to ICU by chemiluminescence method. Among the 45 patients who survived 2 days after ICU admission, 17 patients had multiple organ dysfunction syndrome (MODS group) and 28 patients without MODS (non-MODS group). All patients were recorded for age, glucose, and APACHE II scores on day 1 of admission to the ICU. Results Serum levels of FT3 decreased in 41 (91%) of the 45 surviving patients and elevated serum cortisol levels in 33 (73%) patients, especially at the first 24 h of disease. MODS group indicators than non-MODS group changes significantly. Six patients died of serum FT4 decreased significantly. The level of serum FT3 was negatively correlated with APACHEⅡand the level of COR was positively correlated with APACHEⅡ. Conclusions Serum thyroid hormone and cortisol levels in critically ill patients are related to the severity of the disease. The changes of hormones in MODS patients are more significant than those in non-MODS patients. The decline of serum FT4 is consistent with the severity of the disease, which may be used as an index to judge the prognosis.