血清三碘甲腺原氨酸水平与急性冠状动脉综合征病变特点及心功能变化的临床研究
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摘要
目的探讨低三碘甲腺原氨酸(T3)综合征(ESS)T3水平与急性冠状动脉综合征(ACS)病变特点以及心功能指标的关系。方法采用回顾性病例分析,对217例ACS并ESS及非ESS患者的T3水平以及心功能指标进行分析,明确T3水平与ACS病变特点以及与心功能指标的关系。结果 ACS合并ESS患者STEMI组总三碘甲腺原氨酸(TT3)、游离三碘甲腺原氨酸(FT3)值明显低于未合并组(P<0.05),NSTEMI以及不稳定型心绞痛(UA)患者合并ESS组TT3、FT3值低于未合并组,但差异无统计学意义(P>0.05);ACS合并ESS患者STEMI组FT3与TT3值与NSTEMI和UA组相比明显低下(P<0.05);STEMI广泛前壁或≥2部位梗死组TT3、FT3值低于单一部位梗死组(P<0.05);ACS合并ESS患者TIMI高危组FT3与TT3值与TIMI中危、低危组相比明显低下(P<0.05),且仅TIMI高危组与未合并组相比有统计学意义的降低(P<0.05);ACS患者合并ESS组NT-pro BNP高于未合并组(P<0.05),左心室射血分数(EF)值明显低于未合并组(P<0.05);c Tn I在合并ESS组以及未合并ESS组间差异无统计学意义。结论 ACS不同临床分型、不同TIMI危险等级、STEMI不同梗死部位TT3和FT3水平不同;ACS并ESS者心功能指标低下。T3水平的测定可能对ACS的诊断、病情判定、预后有一定的参考价值。
Objective To investigate the correlation between T3 level of euthyroid sick syndrome(ESS) and le-sion characteristics of acute coronary syndrome(ACS) and indexes of cardiac function.Methods The T3 level and cardiac function in 217 patients with ACS and ESS and non-ESS patients were retrospectively analyzed.The correlation between T3 level and ACS lesion characteristics and cardiac function indexes was identified.Results The TT3 and FT3 values of ACS patients in STEMI group with ESS were significantly lower than those in non-ESS group(P<0.05),whereas the TT3 and FT3 values in NSTEMI group and UA group with ESS were lower than those in non-ESS group,and there were no statistically significant difference(P>0.05).The TT3 and FT3 values of ACS patients in STEMI group with ESS were significantly lower than those in NSTEMI and UA groups(P<0.05).The TT3 and FT3 values of patients with STEMI locating in extensive anterior wall or ≥2 region in the ventricular wall infarction group were lower than those in single-region infarction group(P<0.05).The TT3 and FT3 values of ACS patients in TIMI high-risk group with ESS were significantly lower than those in TIMI moderate-and low-risk group(P<0.05),and there was statistically significant difference between TIMI high-risk group with ESS and non-ESS group(P<0.05).The NT-pro BNP value of ACS patients in the group with ESS was significantly higher than that in the non-ESS group(P<0.05),whereas the EF value was significantly lower than that in the non-ESS group(P<0.05).There was no significant difference in c Tn I between ESS combination group and non-ESS group.Conclusion The TT3 and FT3 levels in ACS patients with different clinical types,TIMI risk levels and STEMI infarction regions are different.The cardiac function index in patients with ACS and ESS are low.The determination of T3 value favors the diagnosis,evaluation and prognosis of ACS.
Objective To investigate the correlation between T3 level of euthyroid sick syndrome(ESS) and le-sion characteristics of acute coronary syndrome(ACS) and indexes of cardiac function.Methods The T3 level and cardiac function in 217 patients with ACS and ESS and non-ESS patients were retrospectively analyzed.The correlation between T3 level and ACS lesion characteristics and cardiac function indexes was identified.Results The TT3 and FT3 values of ACS patients in STEMI group with ESS were significantly lower than those in non-ESS group(P<0.05),whereas the TT3 and FT3 values in NSTEMI group and UA group with ESS were lower than those in non-ESS group,and there were no statistically significant difference(P>0.05).The TT3 and FT3 values of ACS patients in STEMI group with ESS were significantly lower than those in NSTEMI and UA groups(P<0.05).The TT3 and FT3 values of patients with STEMI locating in extensive anterior wall or ≥2 region in the ventricular wall infarction group were lower than those in single-region infarction group(P<0.05).The TT3 and FT3 values of ACS patients in TIMI high-risk group with ESS were significantly lower than those in TIMI moderate-and low-risk group(P<0.05),and there was statistically significant difference between TIMI high-risk group with ESS and non-ESS group(P<0.05).The NT-pro BNP value of ACS patients in the group with ESS was significantly higher than that in the non-ESS group(P<0.05),whereas the EF value was significantly lower than that in the non-ESS group(P<0.05).There was no significant difference in c Tn I between ESS combination group and non-ESS group.Conclusion The TT3 and FT3 levels in ACS patients with different clinical types,TIMI risk levels and STEMI infarction regions are different.The cardiac function index in patients with ACS and ESS are low.The determination of T3 value favors the diagnosis,evaluation and prognosis of ACS.
引文
[1]Michele C.Heart disease in patients with thyroid dysfunction:hyperthyroidism,hypothyroidism and beyond[J].Anadolu Kardiyol Derg,2013,13(1):62-66.
[2]Anil KS,Arya R,Mehta R,et al.Hypothyroidism and cardiovascular disease:factors,mechanism and future perspectives[J].Curr Med Chem,2013,20(35):4411-4418.
[3]Kim BB,Ku YH,Han JY,et al.Relation of triiodothyronine to subclinical myocardial injury in patients with chest pain[J].Am J Cardiol,2013,111(8):1087-1091.
[4]葛均波.内科学[M].北京:人民卫生出版社,2014:236-255.
[5]陈灏珠.实用内科学[M].北京:人民卫生出版社,2007:1243.
[6]Zhang BW,Peng WH,Wang CF,et al.A low FT3 level as a prognostic marker in patients with acute myocardial infarctions[J].Intern Med,2012,51(21):3009-3015.
[7]Iordanis M,Erietta K,Georgios G,et al.Inhibition of thyroid hormone receptorα1 impairs post-ischemic cardiac performance after myocardial infarction in mice[J].Mol Cell Biochem,2013,379(1-2):97-105.
[8]Cerillo A,Storti S,Kallushi E,et al.The low triiodothyronine syndrome:a strong predictor of low cardiac output and death in patients undergoing coronary artery bypass grafting[J].Ann Thorac Surg,2014,97(6):2089-2095.
[9]Pfister R,Strack N,Wielckens K,et al.The relationship and prognostic impact of low-T3 syndrome and NT-pro-BNP in cardiovascular patients[J].Int J Cardiol,2010,144(2):187-190.
[10]Alessandro P,Elena G,Andrea B,et al.Acute effects of triiodothyronine(T3)replacement therapy in patients with chronic heart failure and low-T3 syndrome:a randomized,placebo-controlled study[J].J Clin Endocrinol Metab,2008,93(4):1351-1358.
[2]Anil KS,Arya R,Mehta R,et al.Hypothyroidism and cardiovascular disease:factors,mechanism and future perspectives[J].Curr Med Chem,2013,20(35):4411-4418.
[3]Kim BB,Ku YH,Han JY,et al.Relation of triiodothyronine to subclinical myocardial injury in patients with chest pain[J].Am J Cardiol,2013,111(8):1087-1091.
[4]葛均波.内科学[M].北京:人民卫生出版社,2014:236-255.
[5]陈灏珠.实用内科学[M].北京:人民卫生出版社,2007:1243.
[6]Zhang BW,Peng WH,Wang CF,et al.A low FT3 level as a prognostic marker in patients with acute myocardial infarctions[J].Intern Med,2012,51(21):3009-3015.
[7]Iordanis M,Erietta K,Georgios G,et al.Inhibition of thyroid hormone receptorα1 impairs post-ischemic cardiac performance after myocardial infarction in mice[J].Mol Cell Biochem,2013,379(1-2):97-105.
[8]Cerillo A,Storti S,Kallushi E,et al.The low triiodothyronine syndrome:a strong predictor of low cardiac output and death in patients undergoing coronary artery bypass grafting[J].Ann Thorac Surg,2014,97(6):2089-2095.
[9]Pfister R,Strack N,Wielckens K,et al.The relationship and prognostic impact of low-T3 syndrome and NT-pro-BNP in cardiovascular patients[J].Int J Cardiol,2010,144(2):187-190.
[10]Alessandro P,Elena G,Andrea B,et al.Acute effects of triiodothyronine(T3)replacement therapy in patients with chronic heart failure and low-T3 syndrome:a randomized,placebo-controlled study[J].J Clin Endocrinol Metab,2008,93(4):1351-1358.