Correlation Between Thyroid Hormone Levels And Short-term Clinical Prognosis In Patients With Gastrointestinal Cancer During Perioperative Period And Its Possible Clinical Significance

BackgroudThyroid hormone plays a physiological role in maintaining basic metabolism.Previous studies have shown that euthyroid sick syndrome(ESS)is common in patients during the perioperative period,and low T3 syndrome is its main symptom.However,the correlation between the changes of thyroid hormone levels and short-term clinical prognosis in patients with gastrointestinal tumor during perioperative period is rarely reported,what this subject is researching.ObjectivesTo investigate the correlation between thyroid hormone levels and the short-term clinical prognosis in patients with gastrointestinal tumor during perioperative period and its possible clinical significance.MethodsA total of 101 patients with gastrointestinal tumor who were admitted to Shandong Provincial Hospital for elective operation from February 2019 to February 2020 were selected as the research objects.Fasting blood was collected from cubital vein in the morning before operation and on the 1st,3rd,and 5th day after the operation.The concentration of free triiodothyroionine(FT3),free tetraiodothyroionine(FT4)and thyroid-stimulating hormone(TSH)were detected by chemiluminescence method,as well as detecting the concentration of fasting blood glucose(FBG),insulin,C-reactive protein(CRP),procalcitonin(PCT),prealbumin(PA),retinol binding protein(RBP)and albumin(Alb).At the same time,the patient's age,body mass index(BMI),time to first flatus,anastomotic leakage and the length of hospital stay were recorded.SPSS 22.0 was used for data analysis.Measurement data were described as mean±standard deviation.Repeated measurement data were analyzed by repeated measurement variance analysis.Normal distributed data was using person linear correlation analysis.Non-normal distributed data was analyzed by spearman correlation analysis.? is set to 0.05.ResultsThe trend test showed that:FT3,FT4 and TSH levels had a significant change during the perioperative period.FT3(4.24± 0.55,3.27±0.86,3.17± 0.73,3.19 ± 0.72;P<0.05),FT4(15.51± 2.23,16.60 ± 3.07,15.11 ± 2.69,14.32 ± 2.94;P<0.05)and TSH(2.29 ± 1.52,1.22 ± 1.98,1.46 ± 1.83,1.99 ± 2.05;P<0.05).Person or spearman correlation analysis showed that:The time of first flatus was negatively correlated with the FT3 level on the 3rd and 5th day after operation(r=-0.302,P<0.05;r=-0.358,P<0.05).The CRP level and the FT3 level were significantly negatively correlated on the 3rd and 5th day after operation(r=-0.289,P<0.05;r=-0.499,P<0.05).The PCT level and FT3 level at each time point during the perioperative period showed a significant negative correlation(P<0.05).There was a significant positive correlation between the Alb level and the FT3 level at each time point during the perioperative period(P<0.05).There was a significant positive correlation between RBP level and FT3 level before operation,on the 3rd and 5th day after operation(r=0.414,r=0.378,r=0.484,P<0.001).The PA level was positively correlated with the FT3 level before operation,on the 3rd and 5th day after operation(r=0.491,r=0.406,r=0.450,P<0.001).There was no significant correlation between fasting blood glucose level and FT3 during the perioperative period(P>0.05).There was a significant positive correlation between peritoneal insulin levels and FT3 before operation and on the 5th day after operation(r=0.260,r=0.417;P<0.05).The HOMA-IR was positively correlated with the FT3 level before operation,on the 5th day after operation(r=0.246,r=0.305,P<0.05).The total hospitalization time had a significantly negative correlation with the FT3 level on the 3rd and 5th day after operation(r=-0.402,r=-0.311;P<0.05).There was a significant negative correlation between the first flatus time and the FT4,TSH levels on 3rd and 5th day after surgery(r=-0.234,r=-0.328,P<0.05;r=-0.306,r=-0.287,P<0.05).On the 5th day after surgery,CRP,Alb,RBP and FT4 levels were significantly correlated(r=-0.240,P=0.040;r=0.273,P=0.020;r=0.328,P=0.005).On the 3rd day after surgery,CRP,Alb and TSH levels were significantly correlated(r=-0.211,P=0.039;r=0.221,P=0.030).Multiple linear regression model analysis showed that:tumor stage,disease type and preoperative levels of corresponding hormone were independently correlated with FT3 and FT4 levels on 3rd day(P<0.05);tumor stage and preoperative TSH levels were independently correlated with TSH levels on 3rd day(P<0.05).Conclusion:Euthyroid sick syndrome clearly occured among gastrointestinal tumor patients during perioperative period,and the concentrations of FT3.FT4 and TSH showed a distinctive trend,in which the reduction of FT3 concentrations is the main tendency.Serum FT3 level during the perioperative period can reflect the recovery of postoperative intestinal function,nutritional status,inflammation level,insulin resistance level and total hospital stay of patients with gastrointestinal tumors.The dynamic monitoring of thyroid hormone levels is helpful to predict the short-term prognosis of patients who have undergone gastrointestinal surgery.Tumor stage,disease type,and preoperative levels of corresponding hormone are independent risk factors affecting postoperative FT3 and FT4 levels;tumor stage and preoperative TSH levels are independent risk factors affecting postoperative TSH levels.The efficacy and safety of TH replacement therapy in patients with gastrointestinal tumors and ESS during the perioperative period was not definited.