Study on the relationship between endocrine hormone and prognosis in critically ill patients
Li Xu, Zhang Zhidan, Zhu Ran, Ma Xiaochun, Department of Intensive Care Unit, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
Corresponding author: Li Xu, Email：xania_02_02@yahoo.com.cn 
                                               [ABSTRACT]

Objective: To investigate the profile of changes in blood glucose、thyroid function and cortisol which occurring under critical illness and to explore the interrelation of these endocrine factors in order to direct clinical therapy.

Method: A total of 51 patients with critical illness were studied in this prospective clinical study, either with multiple organ dysfunction syndrome(MODS, n=17) or without MODS(n=28) except 6 dead patients. Serum thyroid hormone、TSH and cortisol concentrations were measured in 51 patients of intensive care unit(ICU) in the first day by Chemiluminescent Microparticle Immunoassay(CMIA),except six patients of death in two days after hospitalization in ICU, continuing to measure the blood sample of other 45 patients in the third day. Patients’ age, blood glucose and APACHE-II score were recorded at first ICU day.

Results: In the alive 45 patients, serum FT3 decreased in 41 patients(91%)、cortisol increased in 33 patients(73%), especially in the first 24 hours. Compared with non-MODS patients, the level of serum FT3 were much lower in MODS group（1.81±0.30&2.19±0.64，P=0.012）, cortisol were much higher in MODS group（1164.53±219.91&798.34±317.83，P=0.002）, and serum glucose increased markedly（12.1±3.6&8.9±2.5,P=0.027）. Serum FT4 reduced apparently in six dead patients, with remarkable difference comparing with other 45 patients（5.59±0.87& 11.91±3.02，P=0.000）. Serum FT3 was negatively related with APACHE-II score（r=-0.460，P=0.01）, and serum cortisol was positively related with APACHE-II score（r=0.575，P=0.000）.

Conclusions: This clinical study revealed that: I. Blood glucose was increased in critically ill patients and correlated with the severity of illness; II. Thyroid hormone and cortisol were apparently abnormal and correlated with APACHE-II score, especially in MODS patients; III. Serum FT4 might serve as an index to judge the prognosis.
[Key Words] Critically ill patient; Thyroid hormone; Cortisol; APACHE-II score
作者单位：110001，中国医科大学附属第一医院ICU科
通讯作者：李旭，Email：xania_02_02@yahoo.com.cn

        机体在大手术、创伤、重症感染等所致的严重应激状态下，不仅会发生肺脏、心血管、肾脏或胃肠道等脏器功能障碍，也会发生内分泌代谢紊乱，并引起一系列代谢、营养、免疫等方面变化，从而影响病人的临床过程和预后。本文通过动态监测51例不同病因的危重症病人血糖、血清甲状腺激素（thyroid hormone, TH），皮质醇（cortisol, COR）等改变，以了解应激状态下内分泌激素的变化规律以及相互间关系，并了解各项指标与疾病预后的相关性，为是否需要干预治疗提供依据。
一、资料与方法
1研究对象
中国医科大学附属第一医院 ICU病房在2004年11月～2006年5月收治的危重症病人。入选标准：急性生理与慢性健康评分（Acute Physiology And Chronic Health Evaluation II，APACHE-II）≥8分的危重病人；排除标准：年龄小于18岁；既往有甲状腺功能亢进或功能低下，或其它内分泌疾患；因合并免疫性疾病等长期使用糖皮质激素；妊娠。
共有51例病人入选，其中男性35例,女性16例，平均年龄（61±5）岁（19岁～85岁）。所患疾病包括：大手术后肺部感染或急性肺损伤导致呼吸衰竭需要机械通气支持12例，腹膜炎、感染性休克13例，多发创伤9例，脑部疾病6例，心功能不全4例，其他7例。有6例病人于入室两天内死亡，其余45例病人按照美国芝加哥举行的胸病医生学会（ACCP）／危重病医学会（SCCM）联席会议所提出的多脏器功能障碍综合征（Multiple Organ dysfunction Syndrome，MODS）诊断标准，以是否发生MODS分为两组，其中MODS组17例，非MODS组28例，两组病人年龄相近，APACHE-II评分差异显著。
2监测项目与方法
2.1监测项目：记录病人入室时的血糖值(Glucose, GLU)、APACHE-II评分，入室后第一天6:00-8:00am禁食条件下采取外周静脉血检测血清游离三碘甲状腺原氨酸（Free Triiodothyronine,FT3）、游离甲状腺素（Free thyroxine,FT4）和促甲状腺激素（Thyrotropin, TSH）的含量及血清皮质醇的浓度，因入室后2天内6例病人死亡，其余45例于第三天继续采集血样进行检测。
2.2方法：用化学发光法测定血清FT3、FT4和TSH的含量（试剂盒由美国雅培诊断产品部提供，为6C48 ARCHITECT FT3, 6C50 ARCHITECT FT4, 6C52 ARCHITECT TSH; 仪器为美国雅培ARCHITECT I 2000SR）;用化学发光免疫法测定血清COR的浓度（试剂盒由美国德普DPC LKCO1提供，仪器为美国德普DPC IMMULITE）。
3统计学处理
检测数据以均数±标准差表示，采用两个独立样本t检验，P<0.05表明存在显著性差异，P<0.01表明存在高度显著性差异，均有统计学意义；相关性检验采用多元相关分析，P<0.05表明结果有统计学相关性。统计分析均采用SPSS11.5统计软件完成。