Borkowski Jacek, Siemiatkowski Andrzej, Wołczyński Sławomir, Czaban Sławomir Lech, Jedynak Monika
Klinika Anestezjologii i Intensywnej Terapii Akademii Medycznej w Białymstoku.
Pol Merkur Lekarski. 2005 Jan;18(103):45-8.
Septic shock is the reason of human body organs dysfunctions including the hormonal system. There are abnormal thyroid hormones releasing as well. It is also noticed that sepsis caused serious disturbances in pituitary-thyroid axis functions. This is called euthyroid sick syndrom - (ESS).
To qualify the prognostic value of thyroid hormones serum levels changes in patients with septic shock.
20 patients with septic shock were included into study. Septic shock was diagnosed according to AACP/SCCM criteria. The study group was divided into two subgroups: survivors (n = 10) and nonsurvivors (n = 10). 20 healthy volunteers were the control group. Blood for analysis was taken at the moment of septic shock recognition and on the 1st, 2nd, 5th and 10th day of the observation between 8 a.m. and 9 a.m. We studied thyrotropin (TSH), free triiodothyronine fraction (fT3) and free thyroxin fraction (fT4) serum levels, APACHE II and APACHE III score, acute lung injury (ALI) or acute respiratory distress syndrome (ARDS).
During our study we noticed significant decrease of fT3 and TSH serum levels (respectively 2.36 +/- 0.79 pg/ml and 0.76 +/- 1.12mU/I) according to the control group (respectively 3.28 +/- 0.61 pg/ml and 0.95 +/- 0.46mU/l). Nonsurvivors had significantly lower TSH serum level (0.37 +/- 0.62 mU/I) in comparison to survivors (1.27 +/- 1.45 mU/I) in spite of very similar fT3 serum level (respectively 2.45 +/- 0.87 pg/ml and 2.22 +/- 0.66 pg/ml). It could mean that there were disturbances in the pituitary-thyroid axis function in patients who did not survive. Our study did not show any correlations between thyroid hormones serum levels and APACHE II score, APACHE III score, ALI or ARDS.
This study show that low TSH serum level could be a significant prognostic factor of death in patient with septic shock especially with low fT3 serum level. The results also suggest that ESS could be a consequence of pituitary TSH releasing disturbances.
感染性休克是人体包括激素系统在内的器官功能障碍的原因。甲状腺激素释放也存在异常。还注意到脓毒症会导致垂体 - 甲状腺轴功能严重紊乱。这被称为正常甲状腺病态综合征 - （ESS）。
评估感染性休克患者血清甲状腺激素水平变化的预后价值。
20例感染性休克患者纳入研究。根据美国医师协会/危重病医学会标准诊断感染性休克。研究组分为两个亚组：存活者（n = 10）和非存活者（n = 10）。20名健康志愿者为对照组。在识别感染性休克时以及观察的第1、2、5和10天上午8点至9点采集血样进行分析。我们研究了促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（fT3）和游离甲状腺素（fT4）的血清水平、急性生理与慢性健康状况评分系统II（APACHE II）和急性生理与慢性健康状况评分系统III（APACHE III）评分、急性肺损伤（ALI）或急性呼吸窘迫综合征（ARDS）。
在我们的研究中，我们注意到与对照组（分别为3.28±0.61 pg/ml和0.95±0.46 mU/l）相比，fT3和TSH血清水平显著降低（分别为2.36±0.79 pg/ml和0.76±1.12 mU/I）。尽管fT3血清水平非常相似（分别为2.45±0.87 pg/ml和2.22±0.66 pg/ml），但非存活者的TSH血清水平（0.37±0.62 mU/I）明显低于存活者（1.27±1.45 mU/I）。这可能意味着未存活患者的垂体 - 甲状腺轴功能存在紊乱。我们的研究未显示甲状腺激素血清水平与APACHE II评分、APACHE III评分、ALI或ARDS之间存在任何相关性。
本研究表明，低TSH血清水平可能是感染性休克患者死亡的重要预后因素，尤其是fT3血清水平较低时。结果还表明，ESS可能是垂体TSH释放紊乱的结果。
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