Longstreth W T, Manowitz N R, DeGroot L J, Siscovick D S, Mayor G H, Copass M K, Weinmann S, Cobb L A
Department of Neurology, School of Medicine, University of Washington, Seattle, USA.
Thyroid. 1996 Dec;6(6):649-53. doi: 10.1089/thy.1996.6.649.
Previous studies have shown abnormal thyroid hormone profiles during cardiac arrest. We explored this association further by characterizing plasma thyroid hormone profiles in 473 patients with out-of-hospital cardiac arrest and correlating them with clinical outcomes. Paramedics collected blood at the end of attempted resuscitation regardless of success. Bloods were collected and processed in a similar manner from 18 control subjects randomly selected from the community. Total thyroxine and total triiodothyronine were lower and reverse triiodothyronine and thyrotropin were higher in cardiac arrest patients than control subjects (all p < 0.001). Except for reverse triiodothyronine, findings were similar for a subgroup of cardiac arrest patients considered to be previously healthy (n = 30). Being discharged alive was associated with total thyroxine, total triiodothyronine and reverse triiodothyronine concentrations closer to the control range and thyrotropin concentrations farther from it, namely higher. In a multivariate stepwise model, only total triiodothyronine and thyrotropin were significantly associated with outcome. Whether these profoundly abnormal profiles represent a pre-existing state or a sudden change of thyroid hormone concentrations cannot be answered with this retrospective study. These observations suggest that thyroid hormones may play a role in the etiology of cardiac arrest, its prognosis, or both.
先前的研究表明，心脏骤停期间甲状腺激素水平异常。我们通过对473例院外心脏骤停患者的血浆甲状腺激素水平进行分析，并将其与临床结果相关联，进一步探讨了这种关联。无论复苏是否成功，护理人员在尝试复苏结束时采集血液。从社区中随机选取18名对照者，以类似方式采集和处理血液。心脏骤停患者的总甲状腺素和总三碘甲状腺原氨酸水平低于对照者，而反三碘甲状腺原氨酸和促甲状腺激素水平高于对照者（所有p<0.001）。除反三碘甲状腺原氨酸外，在一组被认为先前健康的心脏骤停患者（n = 30）中也有类似发现。存活出院与总甲状腺素、总三碘甲状腺原氨酸和反三碘甲状腺原氨酸浓度更接近对照范围以及促甲状腺激素浓度远离对照范围（即更高）相关。在多变量逐步模型中，只有总三碘甲状腺原氨酸和促甲状腺激素与结果显著相关。这项回顾性研究无法回答这些严重异常的水平是代表甲状腺激素浓度的预先存在状态还是突然变化。这些观察结果表明，甲状腺激素可能在心脏骤停的病因、预后或两者中起作用。
