年龄对合并非甲状腺疾病综合征老年危重病患者的临床意义

Clinical significance of age in non-thyroidal illness syndrome in critically ill elderly patients

摘要:

目的 研究年龄对非甲状腺疾病综合征(NTIS)老年危重病患者的临床意义。方法 回顾性分析2010年1月至2016年5月吉化集团公司总医院重症监护室危重病患者341例,其中甲状腺激素水平正常者152例,NTIS患者189例。按年龄进行二分类处理,比较在<60岁、60～69岁、70～79岁及≥80岁年龄段间NTIS总发生率的差异,并比较NTIS组在上述 4个年龄段间相关临床指标差异。采用SPSS 17.0统计软件对数据进行分析,根据数据类型,组间比较采用t检验或χ²检验。结果 我院ICU危重病患者NTIS总发生率为55.42%(189/341),<60岁、60～69岁、70～79岁及≥80岁组的NTIS发生率依次为42.67%(32/75)、47.47%(47/99)、55.32%(52/94)及79.45%(58/73),组间比较,差异有统计学意义(P＜0.05)。70～79岁组与≥80岁组NTIS患者低三碘甲状原氨酸(T3)和(或)低游离三碘甲状原氨酸(FT3)变异型均显著低于<60岁与60～69岁组,70～79岁组与≥80岁组患者低T3和(或)低FT3且低甲状腺素(T4)变异型占比均显著高于<60岁与60～69岁组,差异均有统计学意义(P＜0.01)。随着年龄增加,NTIS患者B型脑钠肽前体(pro-BNP)及胱抑素C(Cys C)水平显著升高,前白蛋白(PA)水平显著下降,差异有统计学意义(P＜0.01)。与<60岁组患者(12.50%,4/32)比较,≥80岁组(39.66%,23/58)患者28 d死亡率显著升高(P＜0.05),其余年龄组间28 d死亡率比较,差异无统计学意义(P>0.05)。结论 老年危重病患者出现NTIS时提示病情较重,预后较差,≥80岁的高龄危重病患者NTIS发生率明显增高,死亡率明显增高。

Abstract:

Objective To investigate the clinical significance of age on non-thyroidal illness syndrome (NTIS) in critically ill elderly patients. Methods A retrospective analysis was performed on 341 critically ill patients in ICU of General Hospital of Jilin Jihua Group Company from January 2010 to May 2016. Of them, 152 had normal thyroid hormone levels, and 189 patients were diagnosed as having NTIS. Based on their age, the incidences of NTIS were compared among the different age groups (<60,0-69,0-79, and ≥80 years old), and the differences in clinical indicators were also compared in these 4 groups. SPSS statistics 17.0 was used to analyze the data, and Student′s t test or Chi-square test was employed for comparison depending on the types of data. Results The incidence rate of NTIS was 55.42%(189/341) in all the subjects, and the rate was 42.67%(32/75), 47.47%(47/99), 55.32%(52/94) and 79.45%(58/73) respectively for the age groups of <60,0-69,0-79 and over 80 years, with statistically differences among them (P<0.05). For the NTIS patients from the 70-79 and over 80 years old groups, they had obviously lower triiodothyronine(T3) and/or free triiodothyronine(FT3), but higher proportions of low T3 and/or low FT3 and low thyroxine(T4) variant, when compared with the patients from the <60 and 60-69 years old groups (P<0.01). With the increase of age, the NTIS patients had significantly increased levels of pro-B-type natriuretic peptide (pro-BNP) and cystatin C (Cys C) and decreased level of prealbumin (PA) (P<0.01). The 28-day mortality rate was significantly higher in the over 80 years old group (39.66%, 23/58) than the <60 years old group (12.50%, 4/32, P<0.05), but no such difference was seen in other age groups (P>0.05). Conclusion NTIS in critically ill elderly patients suggests worse condition and poorer prognosis. NTIS is more common in the critically ill patients over 80 years old, and these patients have higher mortality.