脓毒症危重患儿非甲状腺疾病综合征的发生及其与IL-6和IL-10的相关性

Association of non-thyroidal illness syndrome with interleukin-6 and interleukin-10 in critically ill children with sepsis

摘要:

目的 回顾性比较脓毒症与非脓毒症危重患儿非甲状腺疾病综合征（NTIS）的发生率，并初步探讨其发生与白细胞介素（IL）-6、IL-10的关系。方法 回顾性收集97例脓毒症患儿（脓毒症组）和80例细菌感染相关非脓毒症危重患儿（非脓毒症组）的基本资料及甲状腺功能检测结果进行分析研究，并将IL-6、IL-10与甲状腺功能指标三碘酪氨酸（T3）、四碘络氨酸（T4）、促甲状腺激素（TSH）进行相关性分析。结果 脓毒症与非脓毒症组年龄、性别比较差异无统计学意义（P > 0.05）。脓毒症组序贯器官衰竭评分、住院时间、呼吸机使用率等均高于非脓毒症组（P < 0.05）。脓毒症组炎症指标C反应蛋白（CRP）、降钙素原（PCT）、IL-6水平均显著高于非脓毒症组（P < 0.05）。脓毒症组甲状腺功能指标T3、T4、游离T3、游离T4、TSH水平均显著低于非脓毒症组（P < 0.05）。脓毒症组NTIS发生率、低T3低T4及低TSH发生率均显著高于非脓毒症组（P < 0.001）。相关分析发现脓毒症和非脓毒症患儿IL-6水平与T3、T4、TSH水平均无相关性（P > 0.05），但两组患儿合并分析显示，IL-6水平与T3、T4水平均存在负相关关系（P < 0.001）。结论 脓毒症患儿相比非脓毒症危重患儿更容易合并NTIS，且高水平IL-6可能是造成NTIS发生的重要原因。

Abstract:

Objective To study the incidence rate of non-thyroidal illness syndrome (NTIS) in critically ill children with or without sepsis and the association of NTIS with interleukin-6 (IL-6) and interleukin-10 (IL-10). Methods A retrospective analysis was performed on the medical data of 97 children with sepsis (sepsis group) and 80 non-sepsis children with bacterial infection (non-sepsis group). The correlations of IL-6 and IL-10 with the thyroid function parameters triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH) were analyzed. Results There were no significant differences in age and sex between the sepsis and non-sepsis groups (P > 0.05). Compared with the non-sepsis group, the sepsis group had a significantly higher Sequential Organ Failure Assessment score, a significantly longer length of hospital stay, and a significantly higher rate of use of ventilator (P < 0.05). As for inflammation markers, the sepsis group had significantly higher levels of C-reactive protein, procalcitonin, and IL-6 than the non-sepsis group (P < 0.05). As for thyroid function parameters, the sepsis group had significantly lower levels of T3, T4, free T3, free T4, and TSH than the non-sepsis group (P < 0.05). Compared with the non-sepsis group, the sepsis group had significantly higher incidence rates of NTIS, low T3 and T4, and low TSH (P < 0.001). The correlation analysis revealed that IL-6 level was not correlated with T3, T4, and TSH levels in children with or without sepsis (P > 0.05), but the pooled analysis of the two groups showed that IL-6 level was negatively correlated with T3 and T4 levels (P < 0.001). Conclusions Children with sepsis have a higher incidence rate of NTIS than those without sepsis. The high level of IL-6 may be associated with the development of NTIS.