PubMed日本語 - 非甲状腺疾患症候群に関する重要な疾患の間の初期の栄養を含む規制の影響と結果とのその関係:無作為対照化臨床試験。―QLifePro医療翻訳医療翻訳 QLifePro


Impact of early nutrient restriction during critical illness on the nonthyroidal illness syndrome and its relation with outcome: a randomized, controlled clinical study.


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Lies Langouche, Sarah Vander Perre, Mirna Marques, Anita Boelen, Pieter J Wouters, Michael P Casaer, Greet Van den Berghe


Clinical Department and Laboratory of Intensive Care Medicine, Division Cellular and Molecular Medicine, University of Leuven (KU Leuven), B-3000 Leuven, Belgium.


CONTEXT: Both critical illness and fasting induce low circulating thyroid hormone levels in the absence of a rise in TSH, a constellation-labeled nonthyroidal illness syndrome (NTI). The contribution of restricted nutrition during critical illness in the pathophysiology of NTI remains unclear.


OBJECTIVE: The objective of the study was to investigate the impact of nutrient restriction early during critical illness on the NTI, in relation to outcome.


DESIGN AND PATIENTS: A preplanned subanalysis in a group of intensive care unit (ICU) patients admitted after complicated surgery and for whom enteral nutrition was contraindicated (n = 280) of a randomized controlled trial, which compared tolerating pronounced nutritional deficit for 1 week in the ICU [late parenteral nutrition (PN)] with early initiation of parenteral nutrition (early PN).


MEASUREMENTS: Circulating TSH, total T4, T3, rT3, and leptin levels were quantified upon admission and on ICU day 3 or the last day when patients were discharged earlier. After correction for baseline risk factors, the role of these changes from baseline in explaining the outcome benefit of late PN was assessed with the multivariable Cox proportional hazard analysis.


RESULTS: Late PN reduced complications and accelerated recovery. Circulating levels of TSH, total T4, T3, the T3 to rT3 ratio, and leptin levels were all further reduced by late PN. The further lowering of T4 appeared to reduce the outcome benefit of late PN, whereas the further reduction of T3 to rT3 ratio appeared to statistically explain part of the outcome benefit.


CONCLUSIONS: Tolerating nutrient restriction early during critical illness, shown to accelerate recovery, further aggravated the NTI. The statistical analyses suggested that the more pronounced peripheral inactivation of the thyroid hormone with nutrient restriction during critical illness could be a beneficial adaptation, whereas the lowering of T4 could be deleterious.




設計と患者:患者が複雑な手術の後認めた、そして、経腸栄養法が無作為比較試験(非経口栄養(初期のPN)の初期の開始でICU[遅い非経口栄養(PN)]で1週の間顕著な栄養的な欠乏を許容することを比較した)の禁忌だった(n = 280)集中治療室(ICU)の群の事前に計画された下位分析。




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