摘要
目的探讨低T3综合征在急诊重症监护病房（EICU）患者中的发病率以及T3水平对急诊危重症患者预后评估价值。方法选择北京顺义区医院EICU2012年10月至2013年4月收治的危重症患者150例，在人院当天以及住院第3天行甲状腺功能检查并在入院当天进行APACHEⅡ评分，将凡是甲状腺功能检查结果符合低T3综合征诊断的患者分为低T3综合征组共计38例；其余112例为非低T3综合征组。计算150例危重症患者中低T3综合征的发生率并且随访至28d，计算各组28d病死率；利用ROC曲线判断T3值水平对危重症患者死亡预后价值。结果150例人选危重症患者中，低T3综合征的发生率约为25．3％；随访28d，低T3综合征组患者病死率为42．1％，非低T3综合征组患者病死率为29．5％；按28d患者预后进行死亡与存活进行分组，利用ROC曲线检测T3水平对危重症患者死亡预后，并且与APACHEⅡ评分进行比较：曲线下面积T3为0．768（95％CI：0．701～0．835），APACHEII为0．783（95％CI：0．719～0．846），两者比较未达到统计学意义；T3最佳死亡预后判断界值为0．41ng／mL，其敏感度为76．6％，特异度为78．4％。结论伴发低T3综合征的EICU危重患者预后差，T3值指标可以作为危重症患者预后的一个参考指标。
Objective To identify the clinical significance of low triiodothyronine syndrome and the potential impact of triiodothyronine （T3 ） on prognosis in critical patients. Methods A total of 150 critically ill patients enrolled from October 2012 to April 2013 were divided into two groups, namely low thyroidhormone group （n =38, group A） and normal T3 group （n = 112, group B）. APACHE Ⅱ scores of patients were recorded at admission and thyroid hormone levels were measured on the first and the third day after admission. Then the survival state of 28-day in each group was observed and then the relationship between prognosis and T3 levels was analyzed by receiver operating characteristic （ROC） curve. Results About 25.3% of 150 critical patients were suffered from low thyroidhormone syndrome and the mortality rate in this group was 42. 1% , which was much higher than 29. 5% in normal T3 group. There was no difference in prediction of death rate analyzed by ROC curve between the T3 level and APACHE Ⅱ scores. The area under curve of T3 level was 0. 768 （95% CI： 0. 7014）. 835） and APACHE Ⅱ was 0. 783 （95% （3： O. 7194）. 846）. Best cut-off value of T3 level was 0. 41 ng/mL resulting in 76. 6% sensitivity and78.4% specificity. Conclusions Critically ill patients complicated with low thyroidhormone syndrome has poor prognosis and T3 may be a predictive marker in evaluating the prognosis of critically ill patients.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2013年第10期1132-1135,共4页
Chinese Journal of Emergency Medicine
