Objective To explore the changes of thyroid hormone and TNF-α in severe patients which occurring under critical illness and to explore the interrelation of these endocrine factors in order to direct clinical therapy. Methods Serum thyroid hormone and TNF-αin 102 severe patients and 80 healthy volunteers were detected by radioimmunoassay and enzymoimmunoassay. The results were analyzed and compared with normal subjects,groups of different prognosis,MODS group and no MODS group. Results TT3,FT4,FT3 levels in severe pa-tients were lower than that in normal subjects(P <0. 01),By contrast,TNF-α level were significantly higher than that of control group (P<0. 01). As the situation became worse,the above changes were more obvious in severe patients as compared with normal subjects. For TT3 and TNF-α level,the differences in the early stages of the disease (3 ~7rd) in the survival group and death group were significant (P<0. 05). Compared with non-MODS group,TT3,FT4,FT3 and TNF-α changed significantly in MODS group(P<0. 05). Conclusion TNF-α and thyroid hormone levels play important roles in the severe patients. The changes of TNF-αand thyroid hormone levels can be used for severe patients prediction and treatment.

Objective To evaluate the effection of high mobility group box1protein on septic shock patients with the treatment of glutamine and to demonstrate the mechanism of the treatment of glutamine in patients with septic shock .Methods Seventy-two septic shock cases were selected in ICU of the hospital in May 2009 to July 2012 ,and then two groups were randomly divided ,just named control group and experimental group .After the traditional treatment ,such as fluid resuscitation ,antibiotic therapy and the use of breathing machine ,the control group received low-calorie parenteral nutrition and the experimental group received low-calorie parenteral nutrition combined with intravenous injection of glutamine .APACHEⅡscore ,the concentrations of serum glutamine and HMGB1 were detected at 4 different time points before treatment and the 1st ,3rd ,7th day after the treatment ,to analyze the effec-tion of the change of serum HMBD1 on septic shock patients with the treatment of glutamine .Results The serum glutamine and HMGB1 concentrations were detected with RP-HPLC and ELISA respectively .The result showed that with the intra-group com-parison ,APACHEⅡscores of both two groups after the treatment were lower than that before treatment ,and compare with the control ,the APACHEⅡscore of the experimental group was significantly lower .With disease duration increased ,the concentration of serum glutamine(409 .63 ± 158 .74)μmol/L in the control group was significantly decreased from 3 days after treatment ,that in the experimental group from 1 day (503 .92 ± 167 .66)μmol/L were gradually increased .the HMGB1 concentration in the control group did not appear change ,but that in the experimental group from 1 day (29 .24 ± 23 .91)ng/mL was decreased .Meanwhile ,the level of serum HMGB1[(34 .23 ± 23 .69)ng/mL ,(29 .24 ± 23 .91)ng/mL] concentration decreased synchronized with the changes in concentration of serum glutamine[(470 .05 ± 152 .40)μmol/L ,(503 .92 ± 167 .66)μmol/L] .Conclusion the application of Gluta-mine in treatment of septic shock existed positive significance for patients ,which can effectively increased the concentration of serum glutamine and reduced the concentration of HMGB1 ,to improve the prognosis of patients with septic shock .