云南地区慢性心力衰竭患者甲状腺激素水平变化特点的调查分析
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摘要
【摘要】目的分析云南地区慢性心力衰竭(CHF)患者甲状腺激素(TH)变化特点。方法选取2009—2015年大理大学第一附属医院和曲靖市第一人民医院收治的CHF患者1 083例,其中纽约心脏病协会(NYHA)分级Ⅱ级286例,Ⅲ级439例,Ⅳ级358例;心力衰竭类型:射血分数正常的心力衰竭(HFpEF)651例,射血分数下降的心力衰竭(HFrEF)285例,147例患者左心室射血分数(LVEF)数据缺失;基础疾病:冠心病277例,高血压心脏病298例,其他508例。记录CHF患者低三碘甲状腺原氨酸(T_3)综合征发生情况,并比较不同NYHA分级、心力衰竭类型、基础疾病CHF患者TH水平。结果1 083例CHF患者发生低T_3综合征226例,发生率为20.9%。NYHA分级Ⅳ级患者游离三碘甲状腺原氨酸(FT_3)、总三碘甲状腺原氨酸(TT_3)水平低于NYHA分级Ⅱ、Ⅲ级患者(P<0.05);不同NYHA分级CHF患者游离甲状腺(FT_4)、总甲状腺(TT_4)、促甲状腺激素(TSH)水平比较,差异无统计学意义(P>0.05)。HFrEF患者FT_3、TT_3水平低于HFpEF患者(P<0.05);HFrEF与HFpEF患者FT_4、TT_4、TSH水平比较,差异无统计学意义(P>0.05)。不同基础疾病患者FT_3、TT_3、FT_4、TT_4、TSH水平比较,差异无统计学意义(P>0.05)。结论云南地区CHF患者低T_3综合征发生率较高,以TT_3、FT_3水平变化为主,且TT_3、FT_3水平随着CHF患者心功能恶化程度加重、LVEF降低而降低。
Objective To investigate on changes of thyroid hormone levels in chronic heart failure patients in Yunnan. Methods A total of 1,083 patients with chronic heart failure were selected in the First Affiliated Hospital of Dali University and the First People's Hospital of Qujing from 2009 to 2015,thereinto 286 cases with Ⅱ-grade NYHA grading were served as A1 group,439 cases with Ⅲ-grade NYHA grading were served as A2 group,358 cases with Ⅳ-grade NYHA grading were served as A3 group;651 cases with preserved ejection fraction were served B1 group,285 cases with reduced ejection fraction were served B2 group,and LVEF data was deficient in 147 cases;277 cases with coronary heart disease were served as C1 group,298 cases with hypertensive heart disease were served as C2 group,508 cases with other underlying diseases were served as C3 group. Incidence of low T_3 syndrome was recorded,thyroid hormone levels were compared in A1 group,A2 group and A3 group,between B1 group and B2 group,in C1 group,C2 group and C3 group. Results The incidence of low T_3 syndrome was 20.9%(226/1 083). FT_3 and TT_3 in A3 group were statistically significantly lower than those in A1 group and A2 group(P<0.05),while no statistically significant differences of FT_4,TT_4 or TSH was found in A1 group,A2 group and A3 group(P>0.05). FT_3 and TT_3 in B1 group were statistically significantly lower than those in B2 group(P<0.05),while no statistically significant differences of FT_4,TT_4 or TSH was found between B1 group and B2 group(P>0.05). No statistically significant differences of FT_3,TT_3,FT_4,TT_4 or TSH was found in C1 group,C2 group and C3 group(P>0.05). Conclusion Incidence of low T_3 syndrome is relatively high in chronic heart failure patients in Yunnan,which mainly performs as changes of TT_3 and FT_3,meanwhile TT_3 and FT_3 reduced as deterioration of cardiac function exacerbated and LVEF decreased in patients with chronic heart failure.
Objective To investigate on changes of thyroid hormone levels in chronic heart failure patients in Yunnan. Methods A total of 1,083 patients with chronic heart failure were selected in the First Affiliated Hospital of Dali University and the First People's Hospital of Qujing from 2009 to 2015,thereinto 286 cases with Ⅱ-grade NYHA grading were served as A1 group,439 cases with Ⅲ-grade NYHA grading were served as A2 group,358 cases with Ⅳ-grade NYHA grading were served as A3 group;651 cases with preserved ejection fraction were served B1 group,285 cases with reduced ejection fraction were served B2 group,and LVEF data was deficient in 147 cases;277 cases with coronary heart disease were served as C1 group,298 cases with hypertensive heart disease were served as C2 group,508 cases with other underlying diseases were served as C3 group. Incidence of low T_3 syndrome was recorded,thyroid hormone levels were compared in A1 group,A2 group and A3 group,between B1 group and B2 group,in C1 group,C2 group and C3 group. Results The incidence of low T_3 syndrome was 20.9%(226/1 083). FT_3 and TT_3 in A3 group were statistically significantly lower than those in A1 group and A2 group(P<0.05),while no statistically significant differences of FT_4,TT_4 or TSH was found in A1 group,A2 group and A3 group(P>0.05). FT_3 and TT_3 in B1 group were statistically significantly lower than those in B2 group(P<0.05),while no statistically significant differences of FT_4,TT_4 or TSH was found between B1 group and B2 group(P>0.05). No statistically significant differences of FT_3,TT_3,FT_4,TT_4 or TSH was found in C1 group,C2 group and C3 group(P>0.05). Conclusion Incidence of low T_3 syndrome is relatively high in chronic heart failure patients in Yunnan,which mainly performs as changes of TT_3 and FT_3,meanwhile TT_3 and FT_3 reduced as deterioration of cardiac function exacerbated and LVEF decreased in patients with chronic heart failure.
引文
[1]魏锦,李彤,段大为.心力衰竭患者甲状腺激素和B型钠尿肽水平与心功能的关系[J].天津医药,2011,39(6):530-532.
[2]GORINA Y,LENTZNER H.Multiple causes of death in oldage[J].Aging Trends,2008(9):1-9.
[3]姚静.心衰患者甲状腺激素变化分析[J].中华全科医学,2012,10(2):232-233.DOI:10.16766/j.cnki.issn.1674-4152.2012.02.043.
[4]TENG W,SHAN Z,TENG X,et al.Effect of iodine intake on thyroid diseases in China[J].N Engl J Med,2006,354:2783-2793.DOI:10.1056/NEJMoa054022.
[5]张健,张宇辉.多中心、前瞻性中国心力衰竭注册登记研究--病因、临床特点和治疗情况初步分析[J].中国循环杂志,2015,30(5):413-416.DOI:10.16439/j.cnki.1673-7245.2015.11.042.
[6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗2014[J].中华心血管病杂志,2014,42(2):98-122.DOI:10.3760/cma.j.issn.0253-3758.2014.02.004.
[7]高嵩,严洁,张锋,等.甲状腺激素水平对左心室舒张功能障碍患者的早期诊断价值[J].中国循环杂志,2015,30(2):140-143.DOI:10.3969/j.issn.1000-3614.2015.02.012.
[8]GENCER B,COLLET T H,VIRGINI V,et al.Subclinical thyroid dysfunctionand the risk of heart failure events:an indlividual participant data analysis from 6 prospecte cohorts[J].Circulation,2012,126(9):1040-1049.DOI:10.1161/CIRCULATIONAHA.112.096024.
[9]王芳芳,陈章荣,吴新华,等.云南地区慢性心力衰竭患者正常甲状腺功能病态综合征的流行病学调查[J].中国现代医学杂志,2017,27(15):78-81.DOI:10.3969/j.issn.1005-8982.2017.15.016.
[10]ARCOPINTO M,CITTADINI A.Hormonal alterations in heart failure:anabolic impairment in chronic heart failure-diagnostic,prognosticand therapeutic issues[J].Front Horm Res,2014,43:57-69.DOI:10.1159/000360559.
[11]OLIVARES E L,MARASSI M P,FORTUNATO R S,et al.Thyroid function disturbance and type 3 iodothyro-nine deiodinase induction after myocardial infarction in rats a time course study[J].Endocrinology,2007,148(10):4786-4792.DOI:10.1210/en.2007-0043.
[12]WARNER M H,BECKETT G J.Mechanisms behind the nonthyroidal illness syndrome:an update[J].J Endocrinol,2010,205(1):1-13.DOI:10.1677/JOE-09-0412.
[13]WAJNER S M,GOEMANN I M,BUENO A L,et al.IL-6promotes nonthyroidal illness syndrome by blocking thyroxine actⅣation while promoting thyroid hormone inactⅣation in human cells[J].J Clin Invest,2011,121(5):1834-1845.DOI:10.1172/JCI44678.
[14]秦星汉,丁同斌,刘士超,等.血清甲状腺激素水平与冠状动脉慢性完全闭塞病变患者侧支循环形成的相关性研究[J].中国全科医学,2018,21(17):2048-2053.
[15]王春艳,冯玉宝,苏平.低T3综合征与心血管疾病关系的研究进展[J].实用心脑肺血管病杂志,2016,24(12):4-6.DOI:10.3969/j.issn.1007-9572.2018.00.124.
[16]ADLER S M,WARTOFSKY L.The Nonthyroidal Illness Syndrome[J].Endocrinol Metab Clin N Am,2007,36(3):657-672,vi.DOI:10.1016/j.ecl.2007.04.007.
[17]彭发吉,李碧波,陈裕生.甲状腺激素治疗充血性心力衰竭的疗效观察[J].中国现代医学杂志,2002,12(3):77-78.DOI:10.3969/j.issn.1005-8982.2002.03.033.
[2]GORINA Y,LENTZNER H.Multiple causes of death in oldage[J].Aging Trends,2008(9):1-9.
[3]姚静.心衰患者甲状腺激素变化分析[J].中华全科医学,2012,10(2):232-233.DOI:10.16766/j.cnki.issn.1674-4152.2012.02.043.
[4]TENG W,SHAN Z,TENG X,et al.Effect of iodine intake on thyroid diseases in China[J].N Engl J Med,2006,354:2783-2793.DOI:10.1056/NEJMoa054022.
[5]张健,张宇辉.多中心、前瞻性中国心力衰竭注册登记研究--病因、临床特点和治疗情况初步分析[J].中国循环杂志,2015,30(5):413-416.DOI:10.16439/j.cnki.1673-7245.2015.11.042.
[6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.中国心力衰竭诊断和治疗2014[J].中华心血管病杂志,2014,42(2):98-122.DOI:10.3760/cma.j.issn.0253-3758.2014.02.004.
[7]高嵩,严洁,张锋,等.甲状腺激素水平对左心室舒张功能障碍患者的早期诊断价值[J].中国循环杂志,2015,30(2):140-143.DOI:10.3969/j.issn.1000-3614.2015.02.012.
[8]GENCER B,COLLET T H,VIRGINI V,et al.Subclinical thyroid dysfunctionand the risk of heart failure events:an indlividual participant data analysis from 6 prospecte cohorts[J].Circulation,2012,126(9):1040-1049.DOI:10.1161/CIRCULATIONAHA.112.096024.
[9]王芳芳,陈章荣,吴新华,等.云南地区慢性心力衰竭患者正常甲状腺功能病态综合征的流行病学调查[J].中国现代医学杂志,2017,27(15):78-81.DOI:10.3969/j.issn.1005-8982.2017.15.016.
[10]ARCOPINTO M,CITTADINI A.Hormonal alterations in heart failure:anabolic impairment in chronic heart failure-diagnostic,prognosticand therapeutic issues[J].Front Horm Res,2014,43:57-69.DOI:10.1159/000360559.
[11]OLIVARES E L,MARASSI M P,FORTUNATO R S,et al.Thyroid function disturbance and type 3 iodothyro-nine deiodinase induction after myocardial infarction in rats a time course study[J].Endocrinology,2007,148(10):4786-4792.DOI:10.1210/en.2007-0043.
[12]WARNER M H,BECKETT G J.Mechanisms behind the nonthyroidal illness syndrome:an update[J].J Endocrinol,2010,205(1):1-13.DOI:10.1677/JOE-09-0412.
[13]WAJNER S M,GOEMANN I M,BUENO A L,et al.IL-6promotes nonthyroidal illness syndrome by blocking thyroxine actⅣation while promoting thyroid hormone inactⅣation in human cells[J].J Clin Invest,2011,121(5):1834-1845.DOI:10.1172/JCI44678.
[14]秦星汉,丁同斌,刘士超,等.血清甲状腺激素水平与冠状动脉慢性完全闭塞病变患者侧支循环形成的相关性研究[J].中国全科医学,2018,21(17):2048-2053.
[15]王春艳,冯玉宝,苏平.低T3综合征与心血管疾病关系的研究进展[J].实用心脑肺血管病杂志,2016,24(12):4-6.DOI:10.3969/j.issn.1007-9572.2018.00.124.
[16]ADLER S M,WARTOFSKY L.The Nonthyroidal Illness Syndrome[J].Endocrinol Metab Clin N Am,2007,36(3):657-672,vi.DOI:10.1016/j.ecl.2007.04.007.
[17]彭发吉,李碧波,陈裕生.甲状腺激素治疗充血性心力衰竭的疗效观察[J].中国现代医学杂志,2002,12(3):77-78.DOI:10.3969/j.issn.1005-8982.2002.03.033.