非甲状腺性病态综合征.pptVIP

TSH临床变化及意义 TSH 可正常、降低或增高 一般不低于0.05 mIU/mL TSH增高，多在疾病恢复期 J Clin Endocrinol Metab 1999; 84:151-164. TRH临床变化 TRH分泌可能降低 注射TRH可逆转NTIS多环节：TSH、 T4和T3增高 下丘脑功能性障碍，可能是NTIS的基本问题 低TRH→低TSH→低TH分泌 J Clin Endocrinol Metab 1999; 84:151-164. TRH * PaO2/FiO2：呼吸指数 FiO2：吸入氧的分数值 * 2。 Wiersinga WM (2005) Nonthyroidal Illness In: Braverman LE, Utiger RD (eds) The thyroid. Lippincott-Wilkins Publishers, Philadelphia, pp 246–263 * Corticosteroids and dopamine suppress TSH release and conversion of T4 to T3, whereas the use of pharmacologic agents, such as oestrogen, oral contraceptives, high-dose salicylates, phenytoin, alters TH binding to TBG and may also result in deranged TH concentrations. Deiodinases are selenoproteins, while selenium deficiency is frequently observed in sick patients and selenium deficiency decreases D1 activity. However, selenium administration to critically ill patients has not been found to alter serum thyroid hormone levels * Those that suggest that NTIS and other neuroendocrine changes in critical illness may adversely affect outcome propose the use of hormonal intervention to improve outcome. * Burman KD, Wartofsky L. Endocrine and metabolic dysfunction syndromes in the critically ill: thyroid function in the intensive care unit setting. Crit Care Clin 2001;17:43–57. * Ronald J. Koenig.Book Chapter-Clinical Management of Thyroid Disease －Nonthyroidal Illness Syndrome.2009；285－297 * rT3/T3 ratio (indicative of more severe NTIS) * Leslie J.DeGroot, M.D., Department of Medicine, Thyroid Study Unit, The University of Chicago Medical Center, 5841 S. Maryland Avenue, 非甲状腺性病态综合征 Nonthyroidal Illness Syndrome 江苏省中医药研究院检验科 病 例 女性，48岁 因“发热，咳嗽、咳痰，胸痛1周加重，伴呼吸困难1天” 住入ICU 既往有5年“糖尿病”史，无“甲亢、甲减”史 体检：T 38.3℃，Bp 85/50 mmHg 急性重病容，嗜睡，口周发绀，咽部充血（缺氧？感染？） 颈软，甲状腺Ⅰ度，质软、无压痛、无结节（触诊：甲状腺正常） 胸部可见三凹征，两肺呼吸音粗，可闻及大量湿罗音（肺部感染） 心率120次/min 病 例 辅助检查： 血常规： WBC 12.4×109/L，NEU 12.8%，LYM 77.5%， PLT 395×1012/L 生化：Na 138 mmol/L，K 3.38 mmol/L；血糖 21.3 mmol/L；