目的：探讨脓毒症患者早期血清甲状腺激素（ thyroid hormone ， TH）水平与病情严重程度的相关性。方法103例脓毒症非甲状腺疾病患者按照病情严重程度分为脓毒症组（一般脓毒症患者）62例和严重脓毒症组（包括严重脓毒症和感染性休克）41例；所有患者入院当天进行急性生理学及慢性健康状况评分Ⅱ（ APACHEⅡ评分），并测定血清TH[包括血清三碘甲状腺原氨酸（ TT3）、四碘甲状腺原氨酸（ TT4）、游离三碘甲状腺原氨酸（ FT3）、游离四碘甲状腺原氨酸（ FT4）、促TH（ TSH）]水平及动脉血乳酸水平，比较两组患者血清TH水平、血乳酸及APACHEⅡ评分；血清TH水平与血乳酸、APACHEⅡ评分进行直线相关分析。结果严重脓毒症组患者TT3、TT4、FT3、FT4水平低于脓毒症组患者，差异有统计学意义（P＜0．05或＜0．01），而TSH水平的差异无统计学意义（ P ＞0．05）；两组血乳酸和 APACHEⅡ评分比较，差异有统计学意义（ P＜0.01）。血FT3、FT4与APACHEⅡ评分存在负性直线相关关系（r＝-0．218、-0．194，P＜0．05），血TT3、TT4、TSH与APACHEⅡ评分不存在直线相关关系；血清TH与血乳酸不存在直线相关关系。结论脓毒症患者早期甲状腺素（以FT3和FT4为主）水平与其病情严重程度存在相关性，具有重要的临床意义。%Objective To explore the relationship between the levels of serum thyroid hormones ( TH) and the state of severity during the early phase of sepsis .Methods 103 sepsis patients without thyroidal illness were divided into two groups according to their state of severity:a minor sepsis group of 62 patients and a severe sepsis group of 41 patients .The levels of thyroid hormones ( TT3 ,TT 4 , FT3 , FT 4 and TSH ) , blood lactate and chronic health evaluation Ⅱ( APACHEⅡ) score were compared respectively in all patients on the first day .The correlation of the level of thyroid hormone with the APACHEⅡscore and the blood lactate was analyzed as well .Results There were significant differences between the two groups in the levels of serum TT 3 , TT4 , FT3 , FT4 , blood lactate and APACHEⅡscore (P<0.05 or P<0.01).There was no significant difference in the level of serum TSH between the two groups(P>0.05).The levels of serum FT3 and FT4 were significantly correlated with the APACHEⅡscore in those patients (r=-0.218 and -0.194, P<0.05).There was no relationship in serum TT3, TT4 ,TSH with APACHEⅡscore and blood lactate in these patients .Conclusi on The levels of serum thyroid hormones (especially FT3 and FT4 ) are in correspondence with severity of illness and have an important clinical significance in early phase of sepsis patients .
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