ABSTRACT
Objective To investigate clinical characteristics of patients with liver failure accompanied with non-thyroid sick syndrome (NTIS) and the predictive value for short-term prognosis.Methods Ninety patients with liver failure hospitalized in Tianjin Second People's Hospital from January 2013 to December 2017 were retrospectively enrolled.Among them,75 patients (liver failure group) were randomly selected to establish prognostic models and the other 15 were selected for model validation.Another 75 patients at the same time of hospitalization with chronic hepatitis were randomly selected as the control group.The serum free triiodothyronine (FT3),free thyroxine (FT4) and thyroid-stimulating hormone (TSH) were measured by chemiluminescence.The clinical characteristics and survival rates 3 months after admission of patients with liver failure accompanied with NTIS were analyzed.The predictive value of the model for end-stage liver disease (MELD) score,Child-Turcotte-Pugh (CTP) score,chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score,FT3-MELD model and FT3 for prognosis of liver failure were evaluated.Quantitative data were analyzed with Student's t-test and Mann-Whitney U test.Count data were analyzed with chi-square test.Results The liver failure group had significantly lower levels of FT3,TSH and albumin (Alb),but higher levels of total bilirubin (TBil),international normalized ration (INR),serum creatinine (Cr) and FT4 than the control group.NTIS was diagnosed in 50 patients with liver failure (50/75,66.67％).There were 32 deaths in patients with NTIS and 7 in patients with non-NTIS.The difference was statistically significant (x2 =8.654,P =0.003).INR,Cr,FT3,MELD score,CTP score and CLIF-SOFA score were significantly different between the survival and death groups (t =-3.037,t =-2,720,t =4.100,t =-4.221,t =-3.471,and t =-3.901,respectively;all P ＜ 0.01).A negative correlation was observed between FT3 and MELD score (r =-0.439,P ＜ 0.01).The area under the receiver's operating characteristic (ROC) curve of the FT3-MELD model was 0.816,with the optimal cut-off-point of 0.121 7,sensitivity of 0.769 and specificity of 0.833.The areas under the curve of the FT3,MELD score,CTP score and CLIF-SOFA score were 0.794,0.775,0.699,and 0.739,respectively.Conclusions Liver function and thyroid function are poor in patients with liver failure accompanied with NTIS.The FT3-MELD model is superior to CTP score and CLIF-SOFA score in predicting the short-term prognosis in patients with liver failure.
ABSTRACT
Objective To explore the effects of sepsis on the ultrastructure and function of thyroid in rats.Methods This study was performed in the Animal Department of Fujian Medical University,the Key Laboratory of Fujian Provincial Cardiovascular Institute and the Electron.Microscopic Department of Fujian Medical University.Thirty-two pathogen-free male Sprague-Dawley rats weighing 180-220 g selected,and were randomly (random number) divided into control group (C group,n =8),12 hour group (n =8),24 hour group (n =8) and 36 hour group (n =8).The 12 h group,24 h group and 36 h group were established to be sepsis groups.The sepsis model was made by cecal ligation and puncture (CLP).The samples of blood and thyroid tissue of rats in 12 h group were taken 12 hours after modeling,and then the same procedure was done in the rats of 24 h group and 36 h group separately 24 hours and 36 hours after modeling.Blood serum was obtained by centrifugation to detect the thyroid function using measurement of different of kinds of hormones (T3,T4,fT3,fT4,TSH).Thyroid tissue was available to determine the expression of caspase-3,cell apoptosis and change of ultra-microstructure.Raw data were analyzed using SPSS19.0 software.Caspase-3 grey value was determined by Image J software.Thyroid hormone levels were presented as mean ± standard deviation.The differences in levels of different kinds of thyroid hormone among all the groups were determined by one-way ANOVA.TUNEL positive staining and caspase-3 expression were presented as median (P25,P75).Results Compared to the control group,the T4 decreased significantly (P＜0.05) in the 12 h group,the 24 h group and the 36 h group,both the tT3 and the fT4 decreased significantly in the 24 h group and the 36 h group (P ＜0.05),and the T3 decreased significantly in the 36 h group (P ＜ 0.05).The expression of caspase-3 in the 24 h group was higher than that in the C group (P ＜ 0.05).There was significant difference in rate of celt apoptosis in thyroid tissue among those four groups,and both the 24 h group and the 36 h group had higher rate of cell apoptosis than the C group significantly (P ＜0.05).In those sepsis groups,a series of pathological ultrastructural changes were found in thyroid follicular epithelial cells as following:the nucleus became smaller and more distinctly stained,and quite a few vacuoles were visualized in cell.Furthermore,the cell membrane was broken,and nuclei showed pyknosis.Conionclus In sepsis rats,the significant changes of different kinds of thyroid hormone in serum are similar to those found in the thyroidal illness syndrome,the expression of caspase-3 and cell apoptosis in thyroid tissue increase,and pathological change of thyroid follicular epithelial cells can be observed under electron microscopy.