Hifumi Toru, Okada Ichiro, Kiriu Nobuaki, Hasegawa Eiju, Ogasawara Tomoko, Kato Hiroshi, Koido Yuichi, Inoue Junichi, Abe Yuko, Kawakita Kenya, Hagiike Masanobu, Kuroda Yasuhiro
Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa, 761-0793, Japan.
Division of Critical Care Medicine and Trauma, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo, 190-0014, Japan.
World J Emerg Med. 2014;5(4):270-4. doi: 10.5847/wjem.j.issn.1920-8642.2014.04.005.
Although non-thyroidal illness syndrome (NTIS) is considered a negative prognostic factor, the alterations in free triiodothyronine (fT3) levels in trauma patients requiring massive transfusion have not been reported.
A prospective observational study comparing 2 groups of trauma patients was conducted. Group M comprised trauma patients requiring massive transfusions (>10 units of packed red blood cells) within 24 hours of emergency admission. Group C comprised patients with an injury severity score >9 but not requiring massive transfusions. Levels of fT3, free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were evaluated on admission and on days 1, 2, and 7 after admission. The clinical backgrounds and variables measured including total transfusion amounts were compared and the inter-group prognosis was evaluated. Results are presented as mean±standard deviation.
Nineteen patients were enrolled in each group. In both groups, 32 were men, and the mean age was 50±24 years. In group C one patient died from respiratory failure. The initial fT3 levels in group M (1.95±0.37 pg/mL) were significantly lower than those in group C (2.49±0.72 pg/mL; P<0.01) and remained low until 1 week after admission. Initial inter-group fT4 and TSH levels were not significantly different. TSH levels at 1 week (1.99±1.64 µIU/mL) were higher than at admission (1.48±0.5 µIU/mL) in group C (P<0.05).
Typical NTIS was observed in trauma patients requiring massive transfusions. When initial resuscitation achieved circulatory stabilization, prognosis was not strongly associated with NTIS.
尽管非甲状腺疾病综合征（NTIS）被认为是一个不良预后因素，但对于需要大量输血的创伤患者，其游离三碘甲状腺原氨酸（fT3）水平的变化尚未见报道。
进行了一项前瞻性观察性研究，比较两组创伤患者。M组包括在急诊入院后24小时内需要大量输血（>10单位浓缩红细胞）的创伤患者。C组包括损伤严重程度评分>9但不需要大量输血的患者。在入院时以及入院后第1、2和7天评估fT3、游离甲状腺素（fT4）和促甲状腺激素（TSH）水平。比较临床背景和包括总输血量在内的测量变量，并评估组间预后。结果以平均值±标准差表示。
每组纳入19例患者。两组中男性均为32例，平均年龄为50±24岁。C组中有1例患者死于呼吸衰竭。M组的初始fT3水平（1.95±0.37 pg/mL）显著低于C组（2.49±0.72 pg/mL；P<0.01），且在入院后1周内一直保持较低水平。组间初始fT4和TSH水平无显著差异。C组1周时的TSH水平（1.99±1.64 μIU/mL）高于入院时（1.48±0.5 μIU/mL）（P<0.05）。
在需要大量输血的创伤患者中观察到典型的NTIS。当初始复苏实现循环稳定时，预后与NTIS无强烈关联。
