Assesment Of The Relationship Between Thyroid Dysfuncti-o N And MODS Patients Treating With Huang Lian Jie Du Decotion

ObjectiveTo assay the pattern of thyroid hormone alternations in Multiple organ failure syndrome(MODS) patients, andobserve the effects of Huanglian Jiedu Decotion. Discuss the value of using ROC curve to analyze thyroid hoemones for the predictivity of patients with MODS.Methods1. Huang Lian jie du Decotion’s impaction on Nonthyroid illness syndrome in MODS patients:38 MODS patients and 34 SIRS patients were involved in the research who met theinclusion criteria in ICU of the first affiliated hospital of GuangzhouUniversity of Traditional Chinese Medicine from March 2015 to March2016. TheMODS patientswere divided into two groups randomly, patients in treatmentgroup were treated by Huanglian Jiedu Decoction combined with westernmedicine, patients in controlled group were treated with western medicine alone. Thyroid hormone measurements were taken, includingtotalT3(T3), totalT4(T4), freeT3(FT3), freeT4(FT4) andTSH. PCT, CRP, ALB, APACHEIⅡ score accompany with thyroid hormone tests were monitored frompatients who diagnosis MODS, which the first monitor time is within 24h beforetreatment, the end monitor time is the fifth day since treatment.2. Using ROC curve to analyze thyroid hoemones for the predictivity of patients with MODS:the data was analyzed witht-test and ROC curves by SPSS 19.0.Results1. Huang Lian jie du Decotion’s impaction on Nonthyroid illness syndrome in MODS patients:1)Nonthyroid illness syndrome (NTIS) was presented in 34 cases in the MODS group with an incidence of 89%,while the incidence of the control group is 68%. The most proportion in MODS with NTIS was decreased T3 T4 together with FT3. Serum levels of T3 T4 FT3 and FT4 were significantly lower in the MODS group than that in control group, as well as the ratio of T3/T4 and ratio of T3/FT3(P<0.05), there was no difference in TSH.2)There was no significant difference in the level of thyroid hoemone between the traditional Chinese medicine (TCM) treatment group and the western medicine treatment group before treatment. After treatment,serum level of T3 in TCM group was significantly higher than that in the western medicine group(P <0.05). The levels of serum CRP, ALB andAPACHEⅡ scores of the two groups after treatment were lower than those before treatment, meaning that both the treatment were effective. However, the statistical results show that the treatment of TCM group is more effective(P<0.05). Comparing the clinical outcomes between two groups, the mortality rate of the TCM group was 33.3%, significantly lower than western group, which the motality rate was 70%, proved that the outcomes in TCM group is better.3)T3 level was negatively correlated with CRP(r=-0.366, P=0.024<0.05) and APACHEⅡscore (r=-0.666, P<0.05), at the same time, Positively correla ted with ALB(r=0.427,P=0.008<0.01).2. Using ROC curve to analyze thyroid hoemones for the predictivity of patients with MODS:The cut-off values for Predicting Patients with MODS of these indexes showed by receiver oPerating characteristic curve (ROCcu rve)analysis were as follows:T3:cut-off value≤0.87nmol/L, sensitivity:0. 711, sPecificity:0.794, area underthe ROC curve (AUC):0.783;FT3:cut-off v alue≤3.78Pmol/L, sensitivity:0.737, sPecificity:0.676, AUC:0.700;T3/FT3: cut-off value≥0.2405, sensitivity:0.605, sPecificity:0.912, AUC:0.776.Conclusions1. Huang Lian jie du Decotion’s impaction on Nonthyroid illness syndrome in MODS patients:Theincidence of MODS Patients with non thyroid disease is higherthan in general. Huanglian Jiedu Decoctioncan imProve the Prognosisin Patients with MODS, and increase levels of serum thyroid hormone. The mechanism behind it maybe reduced inflammatory reactions and imProved low blood albumin syndrome under stress. Meanwhile, the levels ofserum T3 was negatively correlated with CRP and APACHEⅡ score, Positively correlated with ALB.2. Using ROC curve to analyze thyroid hoemones for the predictivity of patients with MODS:Resuls in the ROC analysis show that T3, FT3and the ratio between T3/FT3 have a certain Predictive value for the occurrence of MODS, among them, T3 has the highest value.