目的 探讨低T3综合征在急诊重症监护病房(EICU)患者中的发病率以及T3水平对急诊危重症患者预后评估价值.方法 选择北京顺义区医院EICU 2012年10月至2013年4月收治的危重症患者150例,在入院当天以及住院第3天行甲状腺功能检查并在入院当天进行APACHEⅡ评分,将凡是甲状腺功能检查结果符合低T3综合征诊断的患者分为低T3综合征组共计38例；其余112例为非低T3综合征组.计算150例危重症患者中低T3综合征的发生率并且随访至28 d,计算各组28 d病死率；利用ROC曲线判断T3值水平对危重症患者死亡预后价值.结果 150例入选危重症患者中,低T3综合征的发生率约为25.3％；随访28 d,低T3综合征组患者病死率为42.1％,非低T3综合征组患者病死率为29.5％；按28 d患者预后进行死亡与存活进行分组,利用ROC曲线检测T3水平对危重症患者死亡预后,并且与APACHEⅡ评分进行比较:曲线下面积T3为0.768 (95％CI:0.701 ～0.835),APACHEⅡ为0.783 (95％ CI:0.719～0.846),两者比较未达到统计学意义；T3最佳死亡预后判断界值为0.41 ng/mL,其敏感度为76.6％,特异度为78.4％.结论 伴发低T3综合征的EICU危重患者预后差,T3值指标可以作为危重症患者预后的一个参考指标.%Objective To identify the clinical significance of low triiodothyronine syndrome and the potential impact of triiodothyronine (T3) on prognosis in critical patients.Methods A total of 150 critically ill patients enrolled from October 2012 to April 2013 were divided into two groups,namely low thyroidhormone group (n =38,group A) and normal T3 group (n =112,group B).APACHE Ⅱ scores of patients were recorded at admission and thyroid hormone levels were measured on the first and the third day after admission.Then the survival state of 28-day in each group was observed and then the relationship between prognosis and T3 levels was analyzed by receiver operating characteristic (ROC) curve.Results About 25.3％ of 150 critical patients were suffered from low thyroidhormone syndrome and the mortality rate in this group was 42.1％,which was much higher than 29.5％ in normal T3 group.There was no difference in prediction of death rate analyzed by ROC curve between the T3 level and APACHE Ⅱ scores.The area under curve of T3 level was 0.768 (95％ CI:0.701-0.835) and APACHE Ⅱ was 0.783 (95％CI:0.719-0.846).Best cut-off value of T3 level was 0.41 ng/mL resulting in 76.6％ sensitivity and 78.4％ specificity.Conclusions Critically ill patients complicated with low thyroidhormone syndrome has poor prognosis and T3 may be a predictive marker in evaluating the prognosis of critically ill patients.
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