Rothwell P M, Udwadia Z F, Lawler P G
Intensive Care Unit, South Cleveland Hospital, Middlesbrough.
Anaesthesia. 1993 May;48(5):373-6. doi: 10.1111/j.1365-2044.1993.tb07006.x.
Concentrations of thyrotropin, total thyroxine, total tri-iodothyronine and cortisol were measured on admission to an intensive care unit in 200 consecutive patients who did not receive dopamine. Thyrotropin concentration was subnormal (< 0.4 mU.l-1) in 25 patients (12%) and increased (> 5.0 mU.l-1) in 27 (13%). Mortality in these groups differed 22-fold (88% and 4% respectively) despite comparable APACHE II outcome predictions (51% and 32%). Thyrotropin concentration correlated positively with total thyroxine concentration (r = 0.46, p < 0.001) and negatively with cortisol concentration (r = -0.56, p < 0.001). In 15 of the patients with increased thyrotropin concentration on admission, repeat measurements were made on recovery and were normal in 13. The high frequency of abnormal thyrotropin concentrations casts doubt on the assumption of euthyroidism in critical illness. Admission thyrotropin concentration is of prognostic value in critically ill patients.
对200例未接受多巴胺治疗的连续入住重症监护病房的患者入院时测定促甲状腺激素、总甲状腺素、总三碘甲状腺原氨酸和皮质醇浓度。25例患者（12%）促甲状腺激素浓度低于正常水平（<0.4 mU.l-1），27例患者（13%）促甲状腺激素浓度升高（>5.0 mU.l-1）。尽管急性生理与慢性健康状况评分系统II（APACHE II）结果预测相当（分别为51%和32%），但这些组的死亡率相差22倍（分别为88%和4%）。促甲状腺激素浓度与总甲状腺素浓度呈正相关（r = 0.46，p < 0.001），与皮质醇浓度呈负相关（r = -0.56，p < 0.001）。在入院时促甲状腺激素浓度升高的15例患者中，康复时进行了重复测量，其中13例恢复正常。促甲状腺激素浓度异常的高发生率使人对危重病患者甲状腺功能正常的假设产生怀疑。入院时促甲状腺激素浓度对危重病患者具有预后价值。
