儿科药学杂志2024，Vol.30Issue(6)：24-29,6.DOI:10.13407/j.cnki.jpp.1672-108X.2024.06.007
血清甲状腺激素对脓毒症患儿病情严重程度的评估价值
Evaluation Value of Serum Thyroid Hormone on Severity of Children with Sepsis
摘要
Abstract
Objective:To explore the change characteristics of serum thyroid hormone levels in children with sepsis,and evaluate the potential predictive value in the severity of disease,so as to provide reference for the clinical diagnosis and treatment of children with sepsis.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 healthy outpatient physical examination were selected as the control group.The experimental group was divided into the septic shock group(70 cases)and sepsis group(134 cases)according to the presence or absence of shock.The clinical data(site of infection,duration of invasive ventilator support,application of vasoactive drugs,distribution of pathogens),serum thyroid hormone levels including triiodothyronine(T3),tetraiodothyronine(T4),free triiodothyronine(FT3),free tetraiodothyronine(FT4),thyroid stimulating hormone(TSH),and Pediatric Critical Illness Score(PCIS)were collected.Results:The PCIS score of septic shock group was lower than that of sepsis group(P＜0.05),and the application rate of vasoactive drugs and support rate of invasive ventilator were higher than those of sepsis group(P＜0.05).The proportion of abdominal infection in the septic shock group was significantly higher than that in the sepsis group,while the proportion of respiratory tract infection was significantly lower than that in the sepsis group(P＜0.05).There were 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 in the experimental group after 1 week of treatment were higher than those at admission(P＜0.05).Analysis of thyroid hormone and severity and prognosis of sepsis showed that T4 level was an independent risk factor for the progression of sepsis to septic shock.Receiver operating characteristics(ROC)curve was used to evaluated the predictive value of thyroid hormone indicators in the severity of sepsis in children.The results showed that the area under ROC area under the curve(AUC)of T4 was 0.746,which was higher than that of FT4,T3 and FT3,with better predictive performance.Conclusion:Children with sepsis and septic shock are accompanied by different degrees of decline in thyroid hormone,which is closely related to the severity of disease,and with the aggravation of the disease,the level of thyroid hormone declines more significantly.The decrease of serum T3,T4,FT3 and FT4 can be used as the predictor of severity of children with sepsis,and the decrease of serum T4 level is an independent risk factor for the progression of sepsis to septic shock.PCIS score has good correlation with thyroid hormone and is of high value in assessing the condition and prognosis of children with sepsis and septic shock.关键词
甲状腺激素/脓毒症/脓毒性休克/儿童/预后Key words
thyroid hormone/sepsis/septic shock/children/prognosis分类
医药卫生引用本文复制引用
林雪梅,肖曙芳,董芳玲..血清甲状腺激素对脓毒症患儿病情严重程度的评估价值[J].儿科药学杂志,2024,30(6):24-29,6.基金项目
国家自然科学基金项目,编号82160367. （）
