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持续静脉血液过对关键病患者甲状腺平衡的影响

Alicja Filipczyk¹, Magdalena A Wujtewicz¹, Michał Okrągły¹

¹Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, 80-211 Gdańsk, Poland.

Journal of clinical medicine

|August 14, 2025

概括

连续静脉血液过 (CVVHDF) 并不能去除甲状腺激素. 在CVVHDF的ICU患者中,甲状腺激素水平的变化是由于降低了神酶活性,而不是激素损失.

科学领域:

关键护理医学关键护理医学
内分泌学在内分泌学.
腎臟病學 (nephrology) 是一種醫學專業.

背景情况:

非甲状腺疾病综合征在重症监护室 (ICU) 患者中很常见.
连续静脉血液过 (CVVHDF) 可能会因为甲状腺激素的小分子大小而去除甲状腺激素.
在CVVHDF期间评估甲状腺激素水平对于了解患者的新陈代谢至关重要.

研究的目的:

为了确定血清甲状腺激素度在CVVHDF期间是否发生变化.
研究CVVHDF在甲状腺激素去除中的作用.
在接受CVVHDF的重症患者中确定甲状腺功能障碍的潜在机制.

主要方法:

一项前性观察性试验,涉及30名急性损伤 (AKI) 的ICU患者,需要CVVHDF.
血液样本采集在CVVHDF前,在治疗期间的多个时间点,以及治疗后.
测量TSH,TRH,FT3,FT4,TT3,TT4,RT3,并计算周围神酶活性 (G_D).

主要成果:

甲状腺刺激激素 (TSH) 和甲状腺激素释放激素 (TRH) 水平在很大程度上保持正常.
自由甲状腺素 (fT4) 和总甲状腺素 (tT4) 是正常的或略低;自由三甲状腺素 (fT3) 和总三甲状腺素 (tT3) 大多是无法检测的.
在CVVHDF期间没有观察到甲状腺激素水平的显著变化;外围神酶活性 (G_D) 低但稳定.
反向三甲氨酸 (rT3) 水平保持在正常范围内.

结论:

CVVHDF不会导致甲状腺激素的显著损失.
在接受CVVHDF的患者中,降低的外周二氧化酶活性,而不是血液过,是导致甲状腺激素度变化的原因.
这一发现澄清了AKI和CVVHDF重症患者的代谢变化.

关键词:

这就是CRRT.CRRT.CRRT.代氧酶的活性活动.甲状腺功能低下症甲状腺功能低下症非甲状腺疾病综合征甲状腺素甲状腺素

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