非甲状腺疾病综合征对严重发热伴血小板减少综合征患者预后及免疫谱的影响
The Impact of Non-Thyroidal Illness Syndromes on The Prognosis and Immune Profile in Severe Fever with Thrombocytopenia Syndrome Patients.
作者信息
Wu Hongxiao, Mu Yameng, Liu Yuanni, Zhang Ruihua, Xu Yanli, Zhang Yuanyuan, Zhao Chenxi, Zhang Wei, Lin Ling, Chen Zhihai
机构信息
National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, People's Republic of China.
Beijing Key Laboratory of Emerging Infectious Diseases, Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, People's Republic of China.
出版信息
Infect Drug Resist. 2025 Mar 13;18:1439-1449. doi: 10.2147/IDR.S506378. eCollection 2025.
BACKGROUND
Non-thyroidal illness syndrome (NTIS) is the most common endocrine dysfunction in critically ill patients and is often associated with poor prognosis. Thyroid dysfunction and immune cell disturbances are frequently observed in patients with severe fever with thrombocytopenia syndrome (SFTS). This study aims to evaluate the impact of NTIS on the prognosis of SFTS patients and to explore the relationship between thyroid hormones (THs) and immune cell profiles.
METHODS
Adult patients admitted to Yantai Qishan Hospital for SFTS from January 2023 to December 2023 with no prior history of thyroid disease were retrospectively recruited. Multivariable regressions were used to assess the associations between NTIS and clinical outcomes. Spearman correlation analysis was conducted to evaluate the relationships between immune cells and THs. SFTS patients with NTIS were categorized into four subtypes based on different levels of FT4 and TSH, and the association between NTIS subtypes and mortality was further analyzed.
RESULTS
Of the 84 SFTS patients included in the study, 62 (73.8%) were diagnosed with NTIS. Independent risk predictors which may affect prognosis of SFTS patients include NTIS subtype ( =0.002), viral load ( = 0.029), FT3 ( = 0.032), and FT4 ( = 0.041). SFTS patients with NTIS exhibited a higher mortality rate compared to euthyroid patients ( = 0.033). Spearman correlation analysis revealed that LYM, LYM%, MONO, MONO%, BAS, CD3+T, CD3+T%, Th, and Th% were positively correlated with FT3, FT4, or TSH levels. NTIS patients were more likely to present with coagulation abnormalities (APTT, = 0.005; D-Dimer, < 0.001), liver enzyme abnormalities (AST, = 0.001), electrolyte imbalances (Sodium, = 0.003), elevated LDH ( = 0.001), and increased ɑ-HBDH ( = 0.003).
CONCLUSION
NTIS is common in SFTS patients, and SFTS patients with NTIS have a lower survival rate compared to euthyroid patients. The mortality risk in NTIS type 3 patients is higher than in those with NTIS type 1.
背景
非甲状腺疾病综合征（NTIS）是危重症患者中最常见的内分泌功能障碍，常与预后不良相关。在严重发热伴血小板减少综合征（SFTS）患者中，经常观察到甲状腺功能障碍和免疫细胞紊乱。本研究旨在评估NTIS对SFTS患者预后的影响，并探讨甲状腺激素（THs）与免疫细胞谱之间的关系。
方法
回顾性招募2023年1月至2023年12月入住烟台奇山医院的成年SFTS患者，这些患者既往无甲状腺疾病史。采用多变量回归分析评估NTIS与临床结局之间的关联。进行Spearman相关性分析以评估免疫细胞与THs之间的关系。根据游离甲状腺素（FT4）和促甲状腺激素（TSH）的不同水平，将患有NTIS的SFTS患者分为四个亚型，并进一步分析NTIS亚型与死亡率之间的关联。
结果
本研究纳入的84例SFTS患者中，62例（73.8%）被诊断为NTIS。可能影响SFTS患者预后的独立风险预测因素包括NTIS亚型（P = 0.002）、病毒载量（P = 0.029）、游离三碘甲状腺原氨酸（FT3）（P = 0.032）和游离甲状腺素（FT4）（P = 0.041）。与甲状腺功能正常的患者相比，患有NTIS的SFTS患者死亡率更高（P = 0.033）。Spearman相关性分析显示，淋巴细胞（LYM）、淋巴细胞百分比（LYM%）、单核细胞（MONO）、单核细胞百分比（MONO%）、嗜碱性粒细胞（BAS）、CD3⁺T细胞、CD3⁺T细胞百分比、辅助性T细胞（Th）和Th细胞百分比与FT3、FT4或TSH水平呈正相关。NTIS患者更易出现凝血异常（活化部分凝血活酶时间，APTT，P = 0.005；D-二聚体，P < 0.001）、肝酶异常（谷草转氨酶，AST, P = 0.001）、电解质失衡（钠，P = 0.003）、乳酸脱氢酶升高（P = 0.001）和α-羟丁酸脱氢酶升高（P = 0.003）。
结论
NTIS在SFTS患者中很常见，与甲状腺功能正常的患者相比，患有NTIS的SFTS患者生存率更低。3型NTIS患者的死亡风险高于1型患者。
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