2026 年第 3 期 第 21 卷

低三碘甲状腺原氨酸综合征和急性生理学与慢性健康状况评分对肺炎克雷伯菌肺炎患者预后评估的临床研究

Clinical study on prognostic evaluation of low triiodothyronine syndrome and acute physiology and chronic health evaluation score in patients with Klebsiella pneumoniae pneumonia

作者：赵海洋王苗苗马帅梅雪

英文作者：Zhao Haiyang Wang Miaomiao Ma Shuai Mei Xue

单位：首都医科大学附属北京朝阳医院急诊医学中心心肺脑复苏北京市重点实验室，北京100020

英文单位：Emergency Medicine Center Beijing Chao-Yang Hospital Capital Medical University Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation Beijing 100020 China

关键词：肺炎；肺炎克雷伯菌；低T3综合征；急性生理学与慢性健康状况评分Ⅱ

英文关键词：Pneumonia;Klebsiellapneumoniae;Lowtriiodothyroninesyndrome;AcutephysiologyandchronichealthevaluationⅡ

• 摘要：

• 目的 探讨低三碘甲状腺原氨酸(T3)综合征（LT3S）和急性生理学与慢性健康状况评分（APACHEⅡ评分）对肺炎克雷伯菌肺炎患者预后的预测价值。方法 回顾性分析2020年1月至2024年12月首都医科大学附属北京朝阳医院收治的肺炎克雷伯菌肺炎患者63例的病历资料，根据30 d存活与否分为存活组（26例）和死亡组（37例）；比较LT3S组（44例）和正常T3组（19 例）患者临床指标，采用受试者工作特征（ROC）曲线下面积(AUC)和Logistic回归分析评价LT3S和APACHEⅡ评分对肺炎克雷伯菌肺炎患者预后的预测价值。结果 死亡组LT3S发生率高于存活组［83.8%（31/37）比50.0%（13/26）］（P=0.004）。Logistic回归分析显示，LT3S和APACHE Ⅱ评分是肺炎克雷伯菌肺炎患者30 d死亡的独立危险因素（均P<0.05）。ROC 曲线分析显示，T3和APACHE Ⅱ评分预测患者30 d死亡的AUC分别是0.930和0.858，差异无统计学意义（P＞0.05）。结论 肺炎克雷伯菌肺炎患者LT3S发生率较高，LT3S和APACHE Ⅱ均是肺炎克雷伯菌肺炎患者30 d死亡的独立危险因素，二者预测效果无明显差异。

• Objective To investigate the predictive value of low triiodothyronine (T3) syndrome (LT3S) and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score for the prognosis of patients with Klebsiella pneumoniae pneumonia. Methods The medical records of 63 patients with Klebsiella pneumoniae pneumonia admitted to Beijing Chao-Yang Hospital, Capital Medical University from January 2020 to December 2024 were retrospectively analyzed. The patients were divided into the survival group (26 cases) and the death group (37 cases) according to 30 d survival status. The clinical indicators were compared between the LT3S group (44 cases) and the normal T3 group (19 cases). The area under the receiver operating characteristic (ROC) curve (AUC) and Logistic regression analysis were used to evaluate the predictive value of LT3S and APACHE Ⅱ score for the prognosis of patients with Klebsiella pneumoniae pneumonia. Results The incidence of LT3S in the death group was higher than that in the survival group ［83.8%(31/37) vs 50.0%(13/26)］（P=0.004）. Logistic regression analysis showed that LT3S and APACHE Ⅱ score were independent risk factors for 30 d death in patients with Klebsiella pneumoniae pneumonia (both P<0.05). ROC curve analysis showed that the AUCs of T3 and APACHE Ⅱ score for predicting 30 d death were 0.930 and 0.858, respectively (P＞0.05). Conclusion The incidence of LT3S is high in patients with Klebsiella pneumoniae pneumonia. Both LT3S and APACHE Ⅱ score are independent risk factors for 30 d death in these patients, and there is no significant difference in their predictive efficacy.