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目的观察肠外营养支持下胃肠道肿瘤患者围手术期甲状腺激素水平变化。方法行R0根治术的胃肠肿瘤患者36例作为肿瘤组。同期收入院的无甲状腺疾病的患者10例作为对照组。肿瘤组术前1天及术后第14天分别检测血清甲状腺激素(TH)。肿瘤组术后给予15～20 kCal/(kg.d)的肠外营养支持5～7 d,肠蠕动恢复后给予清流食并逐渐过度至流食、半流食。用微粒子捕捉酶免疫分析法检测血清FT3、TT3、FT4及TSH含量,荧光偏振免疫分析法检测血清TT4含量,放射免疫分析法检测血清rT3含量。结果肿瘤组术前FT3水平明显低于对照组(P<0.05),rT3水平明显高于对照组(P<0.01)。肿瘤组术后第14天FT3、TT3明显低于术前水平(P<0.05)。rT3明显高于术前水平(P<0.01)。结论①胃肠肿瘤患者术前即已存在非甲状腺疾病综合征(nonthyroid illness syndrome,NTIS);②胃肠肿瘤患者术后NTIS短期内很难完全恢复。
Objective To observe the changes of perioperative thyroid hormone in patients with gastrointestinal cancer under parenteral nutrition support. Methods Thirty-six patients with radical resection of gastrointestinal tumors underwent radical resection of R0 as tumor group. In the same period, 10 cases of patients without thyroid disease in the income hospital served as the control group. Serum thyroid hormone (TH) was measured at 1 day before operation and 14 days after operation in the tumor group. The patients in the tumor group were treated with parenteral nutrition for 15 ~ 20 kCal / (kg · d) for 5-7 days after operation. The levels of FT3, TT3, FT4 and TSH in serum were detected by microparticle capture enzyme immunoassay. The content of TT4 in serum was detected by fluorescence polarization immunoassay. The content of serum rT3 in serum was detected by radioimmunoassay. Results The level of FT3 in the tumor group was significantly lower than that in the control group (P <0.05) and rT3 level was significantly higher than that in the control group (P <0.01). FT3 and TT3 on the 14th postoperative day in the tumor group were significantly lower than those before operation (P <0.05). rT3 was significantly higher than the preoperative level (P <0.01). Conclusion ① Nonthyroidism syndrome (NTIS) preoperatively exists in patients with gastrointestinal neoplasm. ②NTIS in patients with gastrointestinal neoplasm is difficult to recover completely in short term.