伴低三碘甲状腺原氨酸综合征急性心肌梗死患者临床特征及急性心肌梗死预后影响因素分析
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摘要
目的探讨伴低三碘甲状腺原氨酸(T_3)综合征急性心肌梗死患者临床特征及急性心肌梗死预后影响因素。方法对2012年6月—2014年6月内蒙古医科大学附属医院收治的急性心肌梗死260例根据甲状腺功能及心脏超声检查结果分为甲状腺功能正常组(150例)和低T_3综合征组(110例),比较两组临床特征及随访期间心血管事件发生情况,并对急性心肌梗死的预后影响因素进行分析。结果甲状腺功能正常组年龄、总胆固醇、低密度脂蛋白胆固醇、住院时间及辅助持续气道正压通气率低于或短于低T_3综合征组,血清总三碘甲状腺原氨酸(TT_3)、游离三碘甲状腺原氨酸(FT_3)及左心室射血分数高于低T_3综合征组,随访期间再发心肌梗死、新发心力衰竭、心源性猝死及恶性心律失常发生率明显低于低T_3综合征组,差异均具有统计学意义(P<0.05)。单因素Log Rank回归分析显示,年龄、血清FT_3水平、左心室射血分数、高血压病病史及高脂血症史为影响急性心肌梗死患者预后的因素(P<0.05)。多因素Cox比例风险模型分析显示,年龄(≥65岁)、血清FT_3水平(<5.2 pmol/L)和左心室射血分数(<50%)为影响急性心肌梗死患者预后的独立危险因素(P<0.01)。结论血清FT_3水平与急性心肌梗死患者预后有一定相关性,血清FT_3<5.2 pmol/L的急性心肌梗死患者心血管事件发生率增高,预后较差。
Objective To investigate clinical characteristics and influencing factors on prognosis of patients with acute myocardial infarction associated by low triiodothyronine( T_3) syndrome. Methods A total of 260 patients with acute myocardial infarction admitted during June 2012 and June 2014 were divided into euthyroidism group( n = 150) and low T_3 syndrome group( n = 110) according to results of thyroid function and cardiac ultrasound examination. In two groups,clinical characteristics and incidence rate of cardiovascular events during follow-up were compared,and influencing factors on prognosis of patients with acute myocardial infarction were analyzed. Results Compared with those in low T_3 syndrome group,in euthyroidism group,values of age,total cholesterol,low-density lipoprotein cholesterol,hospital stay and assisted continuous positive airway pressure rate were significantly lower; serum total triiodothyronine( TT_3),free triiodothyronine( FT_3) and left ventricular ejection fraction levels were significantly higher; incidence rates of recurrent myocardial infarction,new heart failure,sudden cardiac death and malignant arrhythmia during the follow-up were significantly lower( P < 0. 05). Univariate logrank regression analysis showed that age,serum levels of FT_3,left ventricular ejection fraction,history of hypertension and hyperlipidemia were influencing factors on prognosis of patients with acute myocardial infarction( P < 0. 05). Multivariate Cox proportional hazards model analysis showed that age( ≥65 years old),serum FT_3level( < 5. 2 pmol/L) and score of left ventricular ejection fraction( < 50%) were independent factors on prognosis for acute myocardial infarction( P < 0. 01).Conclusion Serum FT_3 level has a certain relationship with prognosis of patients with acute myocardial infarction,and the incidence rate of cardiovascular events in acute myocardial infarction patients with serum FT_3< 5. 2 pmol/L is increased,and then the prognosis is poor.
Objective To investigate clinical characteristics and influencing factors on prognosis of patients with acute myocardial infarction associated by low triiodothyronine( T_3) syndrome. Methods A total of 260 patients with acute myocardial infarction admitted during June 2012 and June 2014 were divided into euthyroidism group( n = 150) and low T_3 syndrome group( n = 110) according to results of thyroid function and cardiac ultrasound examination. In two groups,clinical characteristics and incidence rate of cardiovascular events during follow-up were compared,and influencing factors on prognosis of patients with acute myocardial infarction were analyzed. Results Compared with those in low T_3 syndrome group,in euthyroidism group,values of age,total cholesterol,low-density lipoprotein cholesterol,hospital stay and assisted continuous positive airway pressure rate were significantly lower; serum total triiodothyronine( TT_3),free triiodothyronine( FT_3) and left ventricular ejection fraction levels were significantly higher; incidence rates of recurrent myocardial infarction,new heart failure,sudden cardiac death and malignant arrhythmia during the follow-up were significantly lower( P < 0. 05). Univariate logrank regression analysis showed that age,serum levels of FT_3,left ventricular ejection fraction,history of hypertension and hyperlipidemia were influencing factors on prognosis of patients with acute myocardial infarction( P < 0. 05). Multivariate Cox proportional hazards model analysis showed that age( ≥65 years old),serum FT_3level( < 5. 2 pmol/L) and score of left ventricular ejection fraction( < 50%) were independent factors on prognosis for acute myocardial infarction( P < 0. 01).Conclusion Serum FT_3 level has a certain relationship with prognosis of patients with acute myocardial infarction,and the incidence rate of cardiovascular events in acute myocardial infarction patients with serum FT_3< 5. 2 pmol/L is increased,and then the prognosis is poor.
引文
[1]王晨阳,刘海燕,曹海涛,等.心肌梗死发生和发展过程中的免疫机制研究[J].解放军医药杂志,2014,26(11):21-23.
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[5]刘畅,鞠晨晖,高传玉,等.舒张性心力衰竭患者血清T3与LVEDP相关性及对预后的影响[J].中国心血管杂志,2016,21(1):32-35.
[6]赵玉英,卫亚丽,汝磊生,等.急性心肌梗死后室间隔穿孔封堵术及PCI术后随访四例[J].解放军医药杂志,2015,27(3):108-111.
[7]葛洪霞,祖凌云,高炜.急性ST段抬高性心肌梗死患者远期死亡的危险因素分析[J].临床心血管病杂志,2014,30(4):308-311.
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[10]薛增明,杨彦立,安巨会,等.甲状腺激素对急性ST段抬高型心肌梗死合并急性心力衰竭患者预后的研究[J].心肺血管病杂志,2015,34(7):533-536.
[11]Kralova Lesna I,Rychlikova J,Vavrova L,et al.Could human cold adaptation decrease the risk of cardiovascular disease?[J].J Therm Biol,2015,52:192-198.
[12]赵冬婧,汤玮,曹树军,等.阿托伐他汀对老年心肌梗死患者心室重构及血清ICAM-1、IL-6、TNF-α表达的影响[J].解放军医药杂志,2016,28(3):54-58.
[13]吴春涛,马士新.瑞舒伐他汀对急性心肌梗死大鼠心肌重构的作用及其机制[J].中国循证心血管医学杂志,2016,8(5):560-563.
[14]张慧,张晔,李丹丹,等.新活素对老年急性心肌梗死患者心率变异性及内皮功能影响[J].中国循证心血管医学杂志,2016,8(5):596-598,601.
[15]谈媛媛.舒芬太尼复合异丙酚在急性心肌梗死镇痛中的应用研究[J].解放军医学杂志,2015,40(7):587-590.
[16]Hemkens L G,Bucher H C.HIV infection and cardiovascular disease[J].Eur Heart J,2014,35(21):1373-1381.
[17]陈志友.单纯性游离T3降低与心血管疾病的相关性研究[J].中国医药科学,2014,4(6):145-147.
[18]Jankauskiene E,Orda P,Rumbinaite E,et al.Left ventricular function by speckle-tracking echocardiography in patients with low-T3syndrome and acute myocardial infarction[J].Medicina(Kaunas),2015,51(4):209-216.
[19]张莉.甲状腺功能减退危象[J].解放军医药杂志,2015,27(11):封2.
[2]沈寿引,黄金燕,龚亚驰.急性心肌梗死后甲状腺激素水平变化特点及判断预后的价值[J].现代中西医结合杂志,2015,24(4):411-412,417.
[3]白民富,高传玉,王宪沛,等.甲状腺功能异常对冠状动脉病变严重程度及患者预后的影响[J].临床心血管病杂志,2014,30(5):420-424.
[4]白民富,高传玉,杨朝宽,等.低T3对冠状动脉病变严重程度及患者预后的影响[J].实用医学杂志,2014,30(7):1158-1161.
[5]刘畅,鞠晨晖,高传玉,等.舒张性心力衰竭患者血清T3与LVEDP相关性及对预后的影响[J].中国心血管杂志,2016,21(1):32-35.
[6]赵玉英,卫亚丽,汝磊生,等.急性心肌梗死后室间隔穿孔封堵术及PCI术后随访四例[J].解放军医药杂志,2015,27(3):108-111.
[7]葛洪霞,祖凌云,高炜.急性ST段抬高性心肌梗死患者远期死亡的危险因素分析[J].临床心血管病杂志,2014,30(4):308-311.
[8]Fontana L,Hu F B.Optimal body weight for health and longevity:bridging basic,clinical,and population research[J].Aging Cell,2014,13(3):391-400.
[9]邵琦,任颖,全军民,等.合并低T3综合征对急性心肌梗死患者预后的影响[J].上海交通大学学报:医学版,2008,28(12):1564-1567.
[10]薛增明,杨彦立,安巨会,等.甲状腺激素对急性ST段抬高型心肌梗死合并急性心力衰竭患者预后的研究[J].心肺血管病杂志,2015,34(7):533-536.
[11]Kralova Lesna I,Rychlikova J,Vavrova L,et al.Could human cold adaptation decrease the risk of cardiovascular disease?[J].J Therm Biol,2015,52:192-198.
[12]赵冬婧,汤玮,曹树军,等.阿托伐他汀对老年心肌梗死患者心室重构及血清ICAM-1、IL-6、TNF-α表达的影响[J].解放军医药杂志,2016,28(3):54-58.
[13]吴春涛,马士新.瑞舒伐他汀对急性心肌梗死大鼠心肌重构的作用及其机制[J].中国循证心血管医学杂志,2016,8(5):560-563.
[14]张慧,张晔,李丹丹,等.新活素对老年急性心肌梗死患者心率变异性及内皮功能影响[J].中国循证心血管医学杂志,2016,8(5):596-598,601.
[15]谈媛媛.舒芬太尼复合异丙酚在急性心肌梗死镇痛中的应用研究[J].解放军医学杂志,2015,40(7):587-590.
[16]Hemkens L G,Bucher H C.HIV infection and cardiovascular disease[J].Eur Heart J,2014,35(21):1373-1381.
[17]陈志友.单纯性游离T3降低与心血管疾病的相关性研究[J].中国医药科学,2014,4(6):145-147.
[18]Jankauskiene E,Orda P,Rumbinaite E,et al.Left ventricular function by speckle-tracking echocardiography in patients with low-T3syndrome and acute myocardial infarction[J].Medicina(Kaunas),2015,51(4):209-216.
[19]张莉.甲状腺功能减退危象[J].解放军医药杂志,2015,27(11):封2.