den Brinker Marieke, Dumas Bertien, Visser Theo J, Hop Wim C J, Hazelzet Jan A, Festen Dederieke A M, Hokken-Koelega Anita C S, Joosten Koen F M
Department of Pediatrics, Division of Pediatric Intensive Care, Erasmus Medical Center - Sophia Children's Hospital, 3000 CB, Rotterdam, The Netherlands.
Intensive Care Med. 2005 Jul;31(7):970-6. doi: 10.1007/s00134-005-2671-8. Epub 2005 Jun 18.
To investigate the time course of thyroid function, factors that affect it, and its relationship to outcome in children surviving meningococcal septic shock.
Observational cohort study in a university-affiliated pediatric intensive care unit (PICU).
We divided the 44 children admitted to the PICU who survived meningococcal septic shock into those with short-stay (<7 days, n=33) or long-stay (>or=7 days, n=11).
Serum thyroid hormone concentrations were determined on PICU admission and after 24 and 48 h. The Pediatric Risk of Mortality score and selected laboratory parameters were used to assess disease severity. On admission all children showed signs of euthyroid sick syndrome: low total triiodothyronine (TT3) and high reverse triiodothyronine (rT3) without compensatory elevated thyrotropin (TSH). Admission rT3 levels and the TT3/rT3 ratio were correlated with C-reactive protein levels and with time from first petechia to admission. Short-stay children only had higher TT3 and lower interleukin 6 levels at admission than long-stay children; after 48 h they showed higher total thyroxin, free thyroxin, TT3, and TSH and lower rT3 than long-stay children. All changes in thyroid parameters within the first 24 h were related to length of PICU stay. In children receiving dopamine TSH levels and TT3/rT3 ratios remained unchanged, whereas both values increased in those who did not receive dopamine or in whom dopamine was discontinued.
All children surviving meningococcal septic shock showed signs of euthyroid sick syndrome on admission. Thyroid hormone level changes in the first 24 h were prognostic for length of PICU stay.
研究脑膜炎球菌性感染性休克存活儿童的甲状腺功能随时间的变化过程、影响因素及其与预后的关系。
在一所大学附属医院的儿科重症监护病房（PICU）进行的观察性队列研究。
我们将入住PICU且存活的44例脑膜炎球菌性感染性休克儿童分为短期住院组（<7天，n = 33）和长期住院组（≥7天，n = 11）。
在PICU入院时、24小时及48小时后测定血清甲状腺激素浓度。采用儿科死亡风险评分及选定的实验室参数评估疾病严重程度。入院时所有儿童均表现为正常甲状腺病态综合征：总三碘甲状腺原氨酸（TT3）降低、反三碘甲状腺原氨酸（rT3）升高，促甲状腺激素（TSH）无代偿性升高。入院时rT3水平及TT3/rT3比值与C反应蛋白水平及从首次出现瘀点至入院的时间相关。短期住院儿童入院时仅TT3较高，白细胞介素6水平低于长期住院儿童；48小时后，他们的总甲状腺素、游离甲状腺素、TT3及TSH水平高于长期住院儿童，rT3水平低于长期住院儿童。最初24小时内甲状腺参数的所有变化均与PICU住院时间相关。接受多巴胺治疗的儿童TSH水平及TT3/rT3比值保持不变，而未接受多巴胺治疗或停用多巴胺的儿童上述两项指标均升高。
所有脑膜炎球菌性感染性休克存活儿童入院时均表现为正常甲状腺病态综合征。最初24小时内甲状腺激素水平变化对PICU住院时间具有预后意义。
