摘要
目的分析连续性血液净化(CBP)对脓毒症患者甲状腺激素水平的影响及其与预后的相关性。方法选取2020年5月-2021年5月安徽医科大学附属安庆医院安庆市立医院收治的脓毒症患者70例,随机分为对照组和观察组,每组35例。对照组采用常规治疗,观察组在对照组基础上采用CBP。比较两组患者治疗前后急性生理与慢性健康评分(APACHEⅡ)及序贯器官衰竭评分(SOFA)。化学发光法检测血清游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺素(FT4)、促甲状腺激素(TSH)和降钙素原(PCT)水平。流式细胞仪测定治疗前后患者T细胞亚群CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)比值。Pearson相关性分析甲状腺激素与APACHEⅡ、SOFA评分之间的相关性。采用Kaplan-Meier方法分析患者总生存率。结果两组患者治疗前APACHEⅡ评分、SOFA评分、FT3、FT4、TSH、PCT、CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)比较差异无统计学意义(P>0.05)。两组患者治疗后APACHEⅡ评分、SOFA评分、PCT低于治疗前,FT3、FT4、TSH、CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)高于治疗前,差异均有统计学意义(P<0.05);且观察组治疗后APACHEⅡ评分、SOFA评分、PCT低于对照组,FT3、FT4、TSH、CD3^(+)、CD4^(+)、CD8^(+)及CD4^(+)/CD8^(+)高于对照组,差异均有统计学意义(P<0.05)。相关性分析显示,FT3、FT4、TSH与APACHEⅡ和SOFA评分呈负相关(r=-0.625、-0.534、-0.547;r=-0.847、-0.602、-0.563;P<0.05);PCT与APACHEⅡ和SOFA评分呈正相关(r=0.624、0.501;P<0.05)。观察组30 d死亡率(2.86%)低于对照组(20.00%),差异有统计学意义(P<0.05)。结论CBP治疗脓毒症患者可降低APACHEⅡ和SOFA评分,改善甲状腺功能,调节T细胞亚群,提高患者预后。
Objective To analyze the effects of continuous blood purification(CBP)on levels of thyroid hormones and its correlation with prognosis in sepsis patients.Methods A total of 70 patients with sepsis admitted to Anqing Hospital Affiliated to Anhui Medical University were enrolled between May 2020 and May 2021.They were randomly divided into control group and observation group,35 cases in each group.The control group was given routine treatment,while observation group was given CBP on the basis of control group.The scores of acute physiology and chronic health evaluation II(APACHE II)and sequential organ failure assessment(SOFA)were compared between the two groups before and after treatment.The levels of serum free triiodothyronine(FT3),free thyroxine(FT4),thyroid-stimulating hormone(TSH)and procalcitonin(PCT)were detected by chemiluminescence method.T cell subsets(CD3^(+),CD4^(+),CD8^(+))and CD4^(+)/CD8^(+)ratio were detected by flow cytometry before and after treatment.The correlation between thyroid hormones and APACHE II,SOFA scores was analyzed by Pearson correlation analysis.The overall survival rate was analyzed by Kaplan-Meier method.Results Before treatment,there was no significant difference in APACHE II score,SOFA score,FT3,FT4,TSH,PCT,CD3^(+),CD4^(+),CD8^(+)or CD4^(+)/CD8^(+)between the two groups(P>0.05).After treatment,APACHE II score,SOFA score and PCT were decreased,while FT3,FT4,TSH,CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)were increased in both groups(P<0.05).After treatment,APACHE II score,SOFA score and PCT in observation group were lower than those in control group,while FT3,FT4,TSH,CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)were higher than those in control group(P<0.05).Correlation analysis showed that FT3,FT4 and TSH were negatively correlated with APACHE II and SOFA scores(r=-0.625,-0.534,-0.547;-0.847,-0.602,-0.563;P<0.05),while PCT was positively correlated with them(r=0.624,0.501;P<0.05).The 30 d mortality rate in observation group was lower than that in control group(2.86%vs.20.00%)(P<0.05).Conclusion CBP could reduce APACHE II and SOFA scores,improve thyroid function,regulate T cell subsets and improve prognosis of sepsis patients.
作者
段俊
黄浩
吴夏琴
祝茹
DUAN Jun;HUANG Hao;WU Xia-qin;ZHU Ru(Department of Nuclear Medicine,Anqing Municipal Hospital,Anqing Hospital Affiliated to Anhui Medical University,Anqing,Anhui 246003;Department of Emergency Medicine,Anqing Municipal Hospital,Anqing Hospital Affiliated to Anhui Medical University,Anqing,Anhui 246003;Department of Laboratory Medicine,Anqing Municipal Hospital,Anqing Hospital Affiliated to Anhui Medical University,Anqing,Anhui 246003;Department of Obstetrics and Gynecology,Anqing Municipal Hospital,Anqing Hospital Affiliated to Anhui Medical University,Anqing,Anhui 246003,China)
出处
《热带医学杂志》
CAS
2022年第3期382-386,共5页
Journal of Tropical Medicine
基金
安徽省卫生健康委科研项目(AHWJ2021b123)
关键词
连续性血液净化
脓毒症
甲状腺激素
预后
Continuous blood purification
Sepsis
Thyroid hormone
Prognosis
作者简介
段俊(1984-),男,本科,主管技师,研究方向:临床检验技术和核医学技术,E⁃mail:20285416@qq.com
