Xu Li, Li Chun-sheng
Department of Emergency, Chaoyang Hospital, Capital University of Medical Sciences, Beijing 100020, China.
Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2007 Mar;19(3):160-4.
To explore the relationship of autonomic nerve system regulation function in patients with systemic inflammatory response syndrome (SIRS) to hypothalamo-pituitary-adrenal axis and to find useful markers to predict the prognosis of patients with SIRS.
Acute physiology and chronic health evaluation II (APACHE II) and multiple organ dysfunction syndrome (MODS) scores were obtained and heart rate variability (HRV) was analyzed with both time-domain and frequency-domain methods. The serum levels of thyroid hormone and cortisol (COR) were measured by radio-immunoassay.
(1) The patients with SIRS showed significantly higher APACHE II scores and MODS scores but lower HRV when compared with the non-SIRS patients and control group (P<0.05 or P<0.01). In addition, in the SIRS group, the non-survivors were found to have statistically higher APACHE II and MODS scores as well as lower HRV than the survivors (all P<0.01). (2) Multiple regression analysis revealed that there was a negative correlation between the outcome of the patients and standard differentiation of NN interval (SDNN), and there was a positive correlation between the outcome of the patients and APACHE II and MODS scores (P<0.01 and P<0.05). The correction rates of prediction in good or bad outcome were 81.1% and 74.5%, respectively. SDNN<or=55 ms may be the prognostic threshold value, and the sensitivity, specification, positive and negative prediction values were 76.2%, 76.7%, 90.4% and 52.6% respectively. (3) The patients with SIRS showed lower thyroid hormone levels of triiodothyronine(T3), tetraiodothyronine(T4), thyroid stimulating hormone(TSH), and higher concentration of COR compared with the non-SIRS patients and healthy controls, and they were correlated with the prognosis of the patients (P<0.05 or P<0.01). (4) In the SIRS group there were positive correlations between concentrations of T3, TSH and HRV, and opposite results were also obtained between the HRV and the concentration of COR, showing negative correlation (P<0.05 or P<0.01). (5) In the death group, there were positive correlations between concentrations of T3, T4, TSH and HRV (P<0.01 or P<0.05). Also in this group, there were positive correlations between MODS scores and COR, but negative correlation between COR and SDNN (P<0.05 or P<0.01).
Evidently the neuroendocrine system exerts significant influences on the severity of disease, function of organs and prognosis. SDNN, concentration of COR, APACHE II and MODS scores were the useful indexes to evaluate the prognosis of the patients with SIRS.
探讨全身炎症反应综合征（SIRS）患者自主神经系统调节功能与下丘脑 - 垂体 - 肾上腺轴的关系，并寻找预测SIRS患者预后的有用指标。
获取急性生理与慢性健康状况评分系统II（APACHE II）和多器官功能障碍综合征（MODS）评分，并采用时域和频域方法分析心率变异性（HRV）。通过放射免疫法测定血清甲状腺激素和皮质醇（COR）水平。
（1）与非SIRS患者及对照组相比，SIRS患者的APACHE II评分和MODS评分显著更高，但HRV更低（P<0.05或P<0.01）。此外，在SIRS组中，发现非存活者的APACHE II和MODS评分在统计学上高于存活者，且HRV更低（均P<0.01）。（2）多元回归分析显示，患者的预后与正常到正常间期标准差（SDNN）呈负相关，与APACHE II和MODS评分呈正相关（P<0.01和P<0.05）。预后良好或不良的预测校正率分别为81.1%和74.5%。SDNN≤55 ms可能是预后阈值，其敏感性、特异性、阳性和阴性预测值分别为76.2%、76.7%、90.4%和52.6%。（3）与非SIRS患者和健康对照相比，SIRS患者的三碘甲状腺原氨酸（T3）、甲状腺素（T4）、促甲状腺激素（TSH）甲状腺激素水平较低，COR浓度较高，且它们与患者的预后相关（P<0.05或P<0.01）。（4）在SIRS组中，T3、TSH浓度与HRV呈正相关，HRV与COR浓度呈相反结果，呈负相关（P<0.05或P<0.01）。（5）在死亡组中，T3、T4、TSH浓度与HRV呈正相关（P<0.01或P<0.05）。在该组中，MODS评分与COR也呈正相关，但COR与SDNN呈负相关（P<0.05或P<0.01）。
显然，神经内分泌系统对疾病严重程度、器官功能和预后有显著影响。SDNN、COR浓度、APACHE II和MODS评分是评估SIRS患者预后的有用指标。
