CAJ | 학술논문

目的探讨脓毒症患者甲状腺功能紊乱的发生情况及其与左心室结构、功能变化的关系.方法入选63例脓毒症患者,入院次日测定血清甲状腺激素和C反应蛋白(CRP)水平,记录患者入院时年龄、性别、疾病、APACHEⅡ评分和后期发生休克及多器官功能障碍综合征(MODS)等一般资料,并在入院24h、第2周、第3周动态观察左心室结构及功能的变化.另选择一般感染组患者(38例)作对照组,比较脓毒症组与对照组甲状腺功能的差别以及早期血清甲状腺激素水平在脓毒症患者不同严重程度的心脏结构及功能改变间的差异性.结果脓毒症患者血清游离三碘甲状腺原氨酸(FT3)、游离甲状腺(FT4)水平均明显低于一般感染组(P＜0.05);而促甲状腺素(TSH)无显著变化(P＞0.05),其左心室变化表现为:左心室舒张功能减低(Ⅰ型)31例,左心室扩大和左心室舒张功能减低(Ⅱ型)18例,左心室扩大、左心室收缩和舒张功能减低(Ⅲ型)14例;与Ⅰ、Ⅱ型比较,Ⅲ型患者血清Fr3、FT4水平显著降低,休克及MODS发生率显著升高而Ⅰ、Ⅱ型患者间上述指标差异均无统计学意义.结论脓毒症患者普遍存在甲状腺功能紊乱,早期血清甲状腺激素水平对疾病后期左心室结构和功能病变具有一定预测作用.
목적 탐토농독증환자갑상선공능문란적발생정황급기여좌심실결구、공능변화적관계.방법 입선63례농독증환자,입원차일측정혈청갑상선격소화C반응단백(CRP)수평,기록환자입원시년령、성별、질병、APACHEⅡ평분화후기발생휴극급다기관공능장애종합정(MODS)등일반자료,병재입원24h、제2주、제3주동태관찰좌심실결구급공능적변화.령선택일반감염조환자(38례)작대조조,비교농독증조여대조조갑상선공능적차별이급조기혈청갑상선격소수평재농독증환자불동엄중정도적심장결구급공능개변간적차이성.결과 농독증환자혈청유리삼전갑상선원안산(FT3)、유리갑상선(FT4)수평균명현저우일반감염조(P＜0.05);이촉갑상선소(TSH)무현저변화(P＞0.05),기좌심실변화표현위:좌심실서장공능감저(Ⅰ형)31례,좌심실확대화좌심실서장공능감저(Ⅱ형)18례,좌심실확대、좌심실수축화서장공능감저(Ⅲ형)14례;여Ⅰ、Ⅱ형비교,Ⅲ형환자혈청Fr3、FT4수평현저강저,휴극급MODS발생솔현저승고이Ⅰ、Ⅱ형환자간상술지표차이균무통계학의의.결론 농독증환자보편존재갑상선공능문란,조기혈청갑상선격소수평대질병후기좌심실결구화공능병변구유일정예측작용.
Objective To investigate the occurrence of thyroid disorders in septic patients and the relationship between thyroid hormone level and the change of left ventricular function.Methods A total of 63 septic patients,43 male and 20 female,aged 50 to 88 years with mean 63.3 ± 18.5,were included in the present study.The thyroid hormone levels and C-reactive protein (CRP) levels were detected in all patients on the next day of admission.Clinical information of each patient was recorded including demographics and co-existed disease,APACHE Ⅱ score at admission and the incidence of shock and subsequent multiple organ dysfunction syndrome (MODS).At 24 hours,the second week and the third week after admission,a serial trans-thoracic echocardiography were performed in all patients to observe changes of left ventricular end diastolic dimension,left ventricular eject fraction and E/A (the ratio between maximal velocity of blood flow at mitral valve orifice in the early diastolic phase and maximal velocity of blood flow of atrium in systolic phase).Another 38 patients with ordinary infections,21 male and 17 female,with mean age 58.6 ± 16.8 (48-84 years) were selected as controls for comparison.The difference in thyroid function between sepsis group and control group was analyzed.The levels of serum thyroid hormone associated with the incidence of shock and MODS were studied among different types of the left ventricular structure and function in sepsis group.Results The levels of serum free tri-iodothyronine (FT3) and free tetra-iodothyronine (FT4) in sepsis group were significantly lower than those in control group (P ＜ 0.05),but there was no difference in level of thyroid stimulating hormone (TSH) between these two groups.The patients with sepsis had three types of the left ventricular dysfunction:diastolic dysfunction without the enlargement of left ventricular (type Ⅰ) in 31 patients,the enlargement of left ventricular with diastolic dysfunction (type Ⅱ) in 18 patients and the enlargement of left ventricular with both systolic and diastolic dysfunction (type Ⅲ) in 14 patients.Compared with the other two types,the type Ⅲ patients had significantly lower levels of FT3 and FT4 and higher incidences of shock and MODS (P ＜ 0.05).No significant difference in TSH level was found among the three types.There were no significantly differences in FT3 and FT4 between type Ⅰ and type Ⅱ,but the higher incidences of shock and MODS were found in type Ⅰ (P ＞ 0.05).Conclusions Most septic patients have thyroid function disorder.Serum thyroid hormone levels in early stage of sepsis have certain role in predicting changes in left ventricular structure and function in the late stage of disease.