Study On Hypothalamo-Pituitary-Adrenal/Thyroidal Axis In Patients With Critical Disorders

Objective: To investigate the changes of related hormones of hypothalamo-pituitary adrenal/thyroidal axis in critical ill patients, and its prognosis value in disease and its significance to clinical practice.Material and Methods: Fifty patients with critical illness hospitalized in ICU of the 1st affiliated hospital of Guang Xi Medical University from March, 2008 to September, 2009 were included . Of the patients ,there are 24 without multiple organ dysfunction syndrome (MODS, group 1)and 19 with MODS (group 2) and 7 dead patients(group 3) within two days after being in hospital.The control group consists of 20 healthy volunteer. ACTH,total COR,FT3,FT4 and TSH were measured by a two-side sequential chemiluminescent immunometric assay, and CBG was measured by a competitive radioimmunoassay, FC was calculated by Coolens equation.Results: The blood levels of FT3 and TSH were significantly lower(all p<0.05) and the value of COR,FC,ACTH and GLU were higher(all p<0.05) in all patients compared with control group.In group 3,the value of FT3,FT4 and TSH were obviously lower(all p<0.05) and COR,FC,ACTH and GLU were higher(all p<0.05)than that in both group 1 and 2. Compared with group 1,the value of FT3 and FT4 were obviously lower(all p<0.05)and COR,FC,ACTH and GLU were higher(all p<0.05)in both group 2 and 3.There is a negative relationship between APACHE-II score and FT4 (r=-0.460,p=0.047) and a positively relationship between APACHE-II score and cortisol (r=0.712, p=0.001).Conclusion1. There are lower blood levels of FT3,TSH and higher of COR,FC,ACTH and GLU in critical illness patients and all the changes are more obvious in those with MODS .2. The level of serum FT4 might be a sensitive index to judge the prognosis.