Crit Care:甲状腺风暴患者早期糖皮质激素治疗效果

2020-08-02 MedSci原创 MedSci原创

该研究的结果表明糖皮质激素的使用不能提高甲状腺风暴患者的生存率。

甲状腺风暴是一种威胁生命的疾病,死亡率超过10%。尽管糖皮质激素已被推荐作为甲状腺风暴的治疗手段,但缺乏基于大规模临床研究的证据。近日,危重病医学领域权威杂志Critical Care上发表了一篇研究文章,该研究的目的是评估糖皮质激素在治疗重度甲状腺风暴患者中的作用。

研究人员使用日本国家行政理赔数据库进行了一项回顾性全国队列研究。该研究纳入了2013年至2017年期间因严重甲状腺风暴而入住重症监护病房的患者。该研究的主要结局是院内死亡率,次要结局是30天之内的死亡率和住院期间的胰岛素治疗。除了倾向得分匹配(PSM)之外,研究人员还使用具有最大似然估计(MLE)和马尔可夫链蒙特卡洛方法(MCMC)的贝叶斯估计的广义线性混合模型(GLMM)进行统计分析。

该研究共纳入了811例患者,其中600例接受糖皮质激素治疗,211例未接受糖皮质激素治疗。早期给予糖皮质激素与甲状腺风暴患者院内死亡率显著改善无关[GLMM(MLE)、GLMM(MCMC)和PSM中校正后比值比(95%置信区间)分别为1.77(0.95-3.34)、1.44(1.14-1.93)和1.46 (0.72-3.00)]。30天内的死亡率结果与院内死亡率的结果几乎相同。但是,糖皮质激素组的胰岛素使用量明显更高。

由此可见,该研究的结果表明糖皮质激素的使用不能提高甲状腺风暴患者的生存率。

原始出处:

Atsushi Senda.et al.Early administration of glucocorticoid for thyroid storm: analysis of a national administrative database.Critical Care.2020.https://ccforum.biomedcentral.com/articles/10.1186/s13054-020-03188-8

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attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 02 18:40:44 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032599, encodeId=ad701032599f7, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Sun Aug 02 17:25:39 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047133, encodeId=a822104e133ee, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, 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    2021-10-24 jiazhoudexue

    看的不是很明白

    0

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    2020-08-02 1465389cm38暂无昵称

    什么是甲状腺风暴?是危象?

    1

    展开1条回复
  5. 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attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 02 18:40:44 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032599, encodeId=ad701032599f7, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Sun Aug 02 17:25:39 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047133, encodeId=a822104e133ee, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Sun Aug 02 17:25:39 CST 2020, time=2020-08-02, status=1, ipAttribution=)]
  6. 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  7. 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attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 02 18:40:44 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032599, encodeId=ad701032599f7, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Sun Aug 02 17:25:39 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047133, encodeId=a822104e133ee, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, 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    2020-08-02 ms4000001329840404

    。。。。。。

    0

  8. 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time=2020-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1701290, encodeId=c5f51e01290c3, content=<a href='/topic/show?id=b5f6e6827fb' target=_blank style='color:#2F92EE;'>#糖皮质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76827, encryptionId=b5f6e6827fb, topicName=糖皮质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0f4230340116, createdName=Tommy1959, createdTime=Sun Nov 01 04:25:39 CST 2020, time=2020-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=805828, encodeId=1137805828bc, content=什么是甲状腺风暴?是危象?, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=969f5129926, createdName=1465389cm38暂无昵称, createdTime=Sun Aug 02 23:13:01 CST 2020, 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authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Tue Aug 04 05:25:39 CST 2020, time=2020-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=805794, encodeId=7892805e9474, content=。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0e735408348, createdName=ms4000001329840404, createdTime=Sun Aug 02 21:01:05 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=805752, encodeId=8b3c805e5207, content=<a href='/topic/show?id=789a103e7459' target=_blank style='color:#2F92EE;'>#甲状腺风暴#</a>这是一个相对新的概念,值得关注和研究。二甲双胍也许会有效果。, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103774, encryptionId=789a103e7459, topicName=甲状腺风暴)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 02 18:40:44 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032599, encodeId=ad701032599f7, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Sun Aug 02 17:25:39 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047133, encodeId=a822104e133ee, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Sun Aug 02 17:25:39 CST 2020, time=2020-08-02, status=1, ipAttribution=)]
    2020-08-02 lovetcm

    #甲状腺风暴#这是一个相对新的概念,值得关注和研究。二甲双胍也许会有效果。

    0

  9. 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time=2020-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1701290, encodeId=c5f51e01290c3, content=<a href='/topic/show?id=b5f6e6827fb' target=_blank style='color:#2F92EE;'>#糖皮质#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76827, encryptionId=b5f6e6827fb, topicName=糖皮质)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0f4230340116, createdName=Tommy1959, createdTime=Sun Nov 01 04:25:39 CST 2020, time=2020-11-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=805828, encodeId=1137805828bc, content=什么是甲状腺风暴?是危象?, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=1, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=969f5129926, createdName=1465389cm38暂无昵称, createdTime=Sun Aug 02 23:13:01 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1307436, encodeId=e458130e436e6, content=<a href='/topic/show?id=b1d766836e4' target=_blank style='color:#2F92EE;'>#激素治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66836, encryptionId=b1d766836e4, topicName=激素治疗)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=bfa6343, createdName=aliceclz, createdTime=Tue Aug 04 05:25:39 CST 2020, time=2020-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1600415, encodeId=7ba91600415a8, content=<a href='/topic/show?id=3565e21649e' target=_blank style='color:#2F92EE;'>#皮质激素#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=22, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=72164, encryptionId=3565e21649e, topicName=皮质激素)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=21015, createdName=heli0118, createdTime=Tue Aug 04 05:25:39 CST 2020, time=2020-08-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=805794, encodeId=7892805e9474, content=。。。。。。, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=0e735408348, createdName=ms4000001329840404, createdTime=Sun Aug 02 21:01:05 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=805752, encodeId=8b3c805e5207, content=<a href='/topic/show?id=789a103e7459' target=_blank style='color:#2F92EE;'>#甲状腺风暴#</a>这是一个相对新的概念,值得关注和研究。二甲双胍也许会有效果。, beContent=null, objectType=article, channel=null, level=null, likeNumber=99, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=103774, encryptionId=789a103e7459, topicName=甲状腺风暴)], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 02 18:40:44 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032599, encodeId=ad701032599f7, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Sun Aug 02 17:25:39 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047133, encodeId=a822104e133ee, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Sun Aug 02 17:25:39 CST 2020, time=2020-08-02, status=1, ipAttribution=)]
    2020-08-02 内科新手

    谢谢梅斯提供这么好的信息,学到很多

    0

  10. 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attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220519/c2ab253484ee4527a2d4e9589a4821ac/45de9bf494a54becb2ea4369c9d11e85.jpg, createdBy=7a3710, createdName=lovetcm, createdTime=Sun Aug 02 18:40:44 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1032599, encodeId=ad701032599f7, content=谢谢梅斯提供这么好的信息,学到很多, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=内科新手, createdTime=Sun Aug 02 17:25:39 CST 2020, time=2020-08-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047133, encodeId=a822104e133ee, content=疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Sun Aug 02 17:25:39 CST 2020, time=2020-08-02, status=1, ipAttribution=)]
    2020-08-02 CHANGE

    疗效只是效果的众多方面之一,还要看对患者的获益,包括生活质量等因素共同决定效果的

    0

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