| 摘要: |
| 目的:探讨脓毒症患儿血清甲状腺激素水平的变化特点,并评估其在脓毒症患儿病情严重程度中的潜在预测价值,为脓毒症患儿临床诊治提供参考。 方法:采用前瞻性研究方法,纳入昆明市儿童医院儿科重症监护室(PICU)2021-2022 年确诊为脓毒症的 204 例患儿为实验组,同期 89 例门诊体检健康儿童为对照组,实验组根据有无合并休克分为脓毒性休克组(70 例)和脓毒症组(134 例)。 收集所有患儿临床资料[感染部位、有创呼吸机支持时间、血管活性药物使用情况、病原菌分布及小儿危重病例评分(PCIS)等],血清甲状腺激素水平包括三碘甲状腺素原氨酸(T3)、四碘甲状腺素原氨酸(T4)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、促甲状腺激素(TSH)等。 结果:脓毒性休克组 PCIS 低于脓毒症组(P<0. 05),血管活性药物使用率、有创呼吸机支持率高于脓毒症组(P<0. 05)。 脓毒性休克组患儿腹腔感染比例高于脓毒症组,呼吸道感染比例低于脓毒症组(P<0. 05)。 脓毒性休克组、脓毒症组和对照组 T3、T4、FT3、FT4、TSH 水平比较差异均有统计学意义(P<0. 05),且随着病情不断加重,其水平呈逐渐下降趋势。 实验组治疗 1 周后血清 T3、T4、FT3 及 FT4 水平均较入院时升高(P<0. 05)。 甲状腺激素与病情严重程度及预后分析表明,T4 水平是影响脓毒症进展为脓毒性休克的独立危险因素。 采用受试者工作特征(ROC)曲线评价甲状腺激素各项指标在脓毒症患儿疾病严重程度中的预测价值,结果显示 T4 的 ROC 曲线下面积(AUC)为0. 746,较 FT4、T3 及 FT3 的 ROC-AUC 更大,预测性能更好。 结论:脓毒症及脓毒性休克患儿均存在甲状腺激素水平不同程度降低,与病情严重程度密切相关,且随着病情加重,甲状腺激素水平降低更显著。 血清 T3、T4、FT3、FT4 水平的降低可作为脓毒症患儿病情严重程度的预测指标,且血清 T4 水平降低是脓毒症进展为脓毒性休克的独立危险因素。 PCIS 与甲状腺激素水平有较好相关性,对脓毒症、脓毒性休克患儿病情评估及预后判断有较高价值。 |
| 关键词: 甲状腺激素 脓毒症 脓毒性休克 儿童 预后 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2024.06.007 |
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| 基金项目:国家自然科学基金项目,编号 82160367 |
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| Evaluation Value of Serum Thyroid Hormone on Severity of Children with Sepsis |
| Lin Xuemei, Xiao Shufang, Dong Fangling |
| (Kunming Children’s Hospital, Kunming 650000, China) |
| Abstract: |
| Objective: To explore the change characteristics of serum thyroid hormone levels in children with sepsis, and evaluate thepotential predictive value in the severity of disease, so as to provide reference for the clinical diagnosis and treatment of children withsepsis. Methods: Prospective research method was used, 204 children diagnosed with sepsis in the Pediatric Intensive Care Unit(PICU) of Kunming Children’ s Hospital from 2021 to 2022 were enrolled as the experimental group, and 89 children with healthyoutpatient physical examination were selected as the control group. The experimental group was divided into the septic shock group (70cases) and sepsis group (134 cases) according to the presence or absence of shock. The clinical data (site of infection, duration ofinvasive ventilator support, application of vasoactive drugs, distribution of pathogens ), serum thyroid hormone levels includingtriiodothyronine ( T3), tetraiodothyronine ( T4), free triiodothyronine ( FT3), free tetraiodothyronine ( FT4), thyroid stimulatinghormone (TSH), and Pediatric Critical Illness Score (PCIS) were collected. Results: The PCIS score of septic shock group was lowerthan that of sepsis group (P<0. 05), and the application rate of vasoactive drugs and support rate of invasive ventilator were higher thanthose of sepsis group (P<0. 05). The proportion of abdominal infection in the septic shock group was significantly higher than that in thesepsis group, while the proportion of respiratory tract infection was significantly lower than that in the sepsis group (P<0. 05). Therewere significant differences in the levels of T3, T4, FT3, FT4 and TSH among the septic shock group, sepsis group and control group (P<0. 05), and the levels showed a decreasing trend with the aggravation of the disease. The serum levels of T3, T4, FT3 and FT4 inthe experimental group after 1 week of treatment were higher than those at admission (P< 0. 05). Analysis of thyroid hormone andseverity and prognosis of sepsis showed that T4 level was an independent risk factor for the progression of sepsis to septic shock. Receiveroperating characteristics (ROC) curve was used to evaluated the predictive value of thyroid hormone indicators in the severity of sepsis inchildren. The results showed that the area under ROC area under the curve (AUC) of T4 was 0. 746, which was higher than that ofFT4, T3 and FT3, with better predictive performance. Conclusion: Children with sepsis and septic shock are accompanied by differentdegrees of decline in thyroid hormone, which is closely related to the severity of disease, and with the aggravation of the disease, thelevel of thyroid hormone declines more significantly. The decrease of serum T3, T4, FT3 and FT4 can be used as the predictor ofseverity of children with sepsis, and the decrease of serum T4 level is an independent risk factor for the progression of sepsis to septicshock. PCIS score has good correlation with thyroid hormone and is of high value in assessing the condition and prognosis of children withsepsis and septic shock. |
| Key words: thyroid hormone sepsis septic shock children prognosis |
