Analysis Of Euthyroid Sick Syndrome In General Hospital

Objective:To analyze the primary disease of hospitalized patients with euthyroid sick syndrome(ESS)and to explore the clinical significance of ESS in patients with chronic kidney disease(CKD).Methods:To collect the clinical data of patients with ESS who are admitted in the Second People's Hospital of Yunnan Province from January 2013 to June 2018,and record the general situation of the patients(including name,age,sex,primary diagnosis,course of disease,concomitant disease,etc.)Serum triiodothyronine(TT3),free triiodothyronine(FT3),serum thyroxine(TT4),serum free thyroxine(FT4),thyroid stimulating hormone(TSH)and laboratory inspection were recorded.The patients were divided into groups according to the types of primary disease,the levels of thyroid hormones in each group were compared.And to analyze the correlation between thyroid hormone index and age and sex.Then the patients with CKD complicated with ESS were used as the study group and the patients with the normal thyroid function as the control group.The thyroid hormones and laboratory inspection were compared between the two groups.And the correlation that between the above indexes and the level of TT3,FT3,TT4,FT4 was explored.Statistical analysis was carried out with SPSS 24.0 software.Results:1.Among 376 patients with ESS,there are 15.7%of the patients in heart disease group,15.43%of the patients in kidney disease group,5.59%of the patients in liver disease group,6.38%of the patients in lung disease group,10.64%of the patients in diabetes mellitus and diabetes mellitus ketoacidosis group,3.46%of the patients in acute cerebrovascular disease group,5.59%of the patients in tumor disease group,37.23%of the patients in multiple diseases combined group.There was a significant difference in the level of FT3,FT4 among different primary diseases(P<0.05),and there was no significant difference in the level of TT3,TT4,TSH among all primary diseases(P>0.05),but there was no significant difference in the level of TT3,TT4,TSH among all kinds of primary diseases(P<0.05).2.In the patients with euthyroid sick syndrome,the number of patients over 60 years old was more than the number of patients under the age of 60.There was no correlation between FT3,TT3,TT4,TSH level and age(P>0.05),while the level of FT4 was correlated with age,and there was statistical significance(P<0.05).There was no gender difference in FT3,TT3,FT4,TT4 level,but there was significant difference in TSH level between sexes(P<0.05).The level of TSH in female was higher than that in male(P<0.05).3.There were significant differences in HB,HDL-C,FPG and serum calcium between CKD complicated with ESS and normal group(P<0.05),There was no significant difference in Hct,TG,TC,LDL-C and serum phosphorus(P>0.05).4.The mortality rate of patients with CKD complicated with ESS was higher than that of normal group,but there was no significant difference between CKD group with ESS and normal group(P>0.05).The re-admission rate of CKD complicated with ESS was higher than that of normal group within half a year(P<0.05),and the difference was statistically significant(P<0 05).5.FT3 was positively correlated with ALB(r=0.425,P<0.05),PA(r=0.270,P<0.05),and negatively correlated with FPG(r=0.391,P<0.05).But it had no correlation with HB,HDL-C and serum calcium(P>0.05).Taking FT3 as dependent variable,FBQ ALB and PA as independent variables,multiple linear regression analysis was carried out.The results showed that ALB and FBG had a great effect on FT3,among which ALB was the most significant.There was no correlation between TT3 and ALB,PA,HB,HDL-C,serum calcium and FPG(P>O.05).FT4 was positively correlated with ALB(r=0.587,P<0.05)and serum calcium(r=0.303,P<0.05),but not with serum PA,HB,HDL-C and FPG(P>0.05).And using FT4 as dependent variable,ALB as independent variable,serum calcium as independent variable,multiple linear regression analysis was carried out.The results showed that ALB had great effect on FT4.TT4 was positively correlated with ALB(r=0.440,P<0.05)and serum calcium(r=0.381,P<0.05),but had no correlation with PA,HB,HDL-C and FPG(P>0.05).And using TT4 as dependent variable,ALB as independent variable,serum calcium as independent variable,multiple linear regression analysis was carried out.The results showed that ALB had great effect on TT4.Conclusion:1.ESS is a common complication,and many kinds of diseases will be associated with ESS.2.ESS was mainly found in patients over 60 years old.There was no correlation between FT3 and age and sex,but the level of TSH in female was higher than that in male.3.ESS is commonly seen in patients with CKD,especially in the intermediate and advanced patients.Monitoring thyroid function can help to assess the condition with CKD.4.Hypoproteinemia and abnormal blood glucose may play an imp6rtant role in the development of ESS in patients with CKD.