甲状腺功能对急性心肌梗死患者心脏射血分数及心血管事件的影响
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摘要
目的探索急性心肌梗死患者甲状腺功能对心脏射血分数的影响。方法采用队列研究法,对2013-01～2016-12我院心内科收治345名急性心肌梗死患者的甲状腺功能及心脏超声心脏射血分数进行数据收集及分析,对患者心血管事件及死亡进行2年的随访记录。采用单元及多元线性回归模型分析甲状腺功能与患者心脏射血分数的相关性。采用Kaplan-Meier生存分析的方法探索甲状腺功能对心血管事件的预测作用。结果急性心肌梗死患者中,血浆T3(R square=0. 04,P<0. 001)、FT3(R square=0. 05,P <0. 001)及TSH(R square=0. 01,P <0. 05)水平与患者心脏射血分数显著相关。随访结果提示血浆T3、FT3和TSH对患者心血管事件预后无显著预测作用。结论急性心肌梗死患者中血浆T3、FT3及TSH水平与心脏射血分数显著相关,但对患者心血管事件无显著预测作用。
Objective To investigate the correlation between thyroid function and cardiac ejection fraction( EF) in patients with acute myocardial infarction. Methods Thyroid function and EF by echocardiography in 345 patients diagnosed with AMI were collected and analyzed. Simple and multi-regression analysis were performed to investigate the correlation between T3,FT3,TSH level and EF. Major adverse cardiovascular events( MACE),including new-onset myocardial infarction,acute heart failure and cardiac death,were documented during the follow-up. Results The plasma T3 level( R square = 0. 04,P < 0. 001),plasma FT3 level( R square = 0. 05,P <0. 001) and TSH level( R square = 0. 01,P < 0. 05) were positively correlated with EF. Kaplan-Meier survival analysis revealed no significant difference with regard to different T3,FT3,TSH levels at the end of the follow-up. Conclusion Plasma T3,FT3 and TSH levels are positively correlated to cardiac function on admission in AMI patients,but may not predict long-time survival rate.
Objective To investigate the correlation between thyroid function and cardiac ejection fraction( EF) in patients with acute myocardial infarction. Methods Thyroid function and EF by echocardiography in 345 patients diagnosed with AMI were collected and analyzed. Simple and multi-regression analysis were performed to investigate the correlation between T3,FT3,TSH level and EF. Major adverse cardiovascular events( MACE),including new-onset myocardial infarction,acute heart failure and cardiac death,were documented during the follow-up. Results The plasma T3 level( R square = 0. 04,P < 0. 001),plasma FT3 level( R square = 0. 05,P <0. 001) and TSH level( R square = 0. 01,P < 0. 05) were positively correlated with EF. Kaplan-Meier survival analysis revealed no significant difference with regard to different T3,FT3,TSH levels at the end of the follow-up. Conclusion Plasma T3,FT3 and TSH levels are positively correlated to cardiac function on admission in AMI patients,but may not predict long-time survival rate.
引文
[1] Martin SS,Daya N,Lutsey PL,et al. Thyroid function,cardio-vascular risk factors,and incident atherosclerotic cardiovasculardisease:The atherosclerosis risk in communities(aric)study[J]. J Clin Endocrinol Metabol,2017,102(9):3306-3315.
[2] Ling Y,Jiang J,Gui M,et al. Thyroid function,prevalent coro-nary heart disease,and severity of coronary atherosclerosis in pa-tients undergoing coronary angiography[J]. Int J Endocrinol,2015,2015:708272.
[3] Wang W,Guan H,Gerdes AM,et al. Thyroid status,cardiacfunction,and mortality in patients with idiopathic dilated cardio-myopathy[J]. J Clin Endocrinol Metabol,2015,100(8):3210-3218.
[4] Wang W,Guan H,Fang W,et al. Free triiodothyronine levelcorrelates with myocardial injury and prognosis in idiopathic dilat-ed cardiomyopathy:Evidence from cardiac mri and spect/pet im-aging[J]. Sci Rep,2016,6(39811.
[5] Rothberger GD,Gadhvi S,Michelakis N,et al. Usefulness ofserum triiodothyronine(T3)to predict outcomes in patients hos-pitalized with acute heart failure[J]. American J Cardiol,2017,119(4):599-603.
[6] Hayashi T,Hasegawa T,Kanzaki H,et al. Subclinical hypothy-roidism is an independent predictor of adverse cardiovascular out-comes in patients with acute decompensated heart failure[J].ESC Heart Failure,2016,3(3):168-176.
[7] Okayama D,Minami Y,Kataoka S,et al. Thyroid function onadmission and outcome in patients hospitalized for acute decom-pensated heart failure[J]. J Cardiol,2015,66(3):205-211.
[8] Ziman ME,Bui HT,Smith CS,et al. The pharmacists'role inimproving guideline compliance for thyroid function testing in pa-tients with heart failure[J]. J Pharm Pract,2012,25(2):195-200.
[9] She J,Feng J,Deng Y,et al. Correlation of triiodothyronine lev-el with in-hospital cardiac function and long-term prognosis in pa-tients with acute myocardial infarction[J]. Dis Markers,2018,2018:5236267.
[10] She J,Hu Z,Deng Y,et al. Chest pain after aortic valve re-placement:Rupture of right sinus of valsalva presenting as myo-cardial infarction[J]. Cardiology,2016,134(1):22-25.
[11] Hollander JE,Than M,Mueller C. State-of-the-art evaluation ofemergency department patients presenting with potential acutecoronary syndromes[J]. Circulation,2016,134(7):547-564.
[12]王思远,王文尧,唐熠达.甲状腺功能减退与急性心肌梗死患者不良心血管事件的相关性研究[J].中国循环杂志,2017,32(z1):7.
[13] Vernon ST,Coffey S,Bhindi R,et al. Increasing proportion of stelevation myocardial infarction patients with coronary atheroscle-rosis poorly explained by standard modifiable risk factors[J].Eur J Prevent Cardiol,2017,24(17):1824-1830.
[14] Kidd SK,Bonaca MP,Braunwald E,et al. Universal classifica-tion system type of incident myocardial infarction in patients withstable atherosclerosis:Observations from thrombin receptor antag-onist in secondary prevention of atherothrombotic ischemic events(tra 2 degrees p)-timi 50[J]. J Am Heart Assoc,2016,5(7):pii:e003237.
[15] Prado-Uribe MDC,Ventura MD,Avila-Diaz M,et al. Low triio-dothyronine is associated with elevation of n-terminal pro-brainnatriuretic peptide(nt-probnp)and mortality in dialysis patients[J]. Nefrologia,2017,37(6):598-607.
[16] Mai W,Janier MF,Allioli N,et al. Thyroid hormone receptoralpha is a molecular switch of cardiac function between fetal andpostnatal life[J]. Proc Natl Acad Sci U S A,2004,101(28):10332-10337.
[17] Swanson EA,Gloss B,Belke DD,et al. Cardiac expression andfunction of thyroid hormone receptor beta and its pv mutant[J].Endocrinology,2003,144(11):4820-4825.
[18] Ojamaa K,Kenessey A,Klein I. Thyroid hormone regulation ofphospholamban phosphorylation in the rat heart[J]. Endocrinolo-gy,2000,141(6):2139-2144.
[19]李慧娣,向定成,张金霞,等.急性心肌梗死早期脑钠肽浓度的动态演变规律及其对心力衰竭的诊断价值[J].南方医科大学学报,2018,38(1):112-116.
[20] Li X,Yao Y,Chen Z,et al. Thyroid-stimulating hormone withinthe normal range and risk of major adverse cardiovascular eventsin non-ischemic dilated cardiomyopathy patients with severe leftventricular dysfunction[J]. Clin Cardiol,2018:Epub ahead ofprint.
[21] Seo SM,Koh YS,Park HJ,et al. Thyroid stimulating hormoneelevation as a predictor of long-term mortality in patients with a-cute myocardial infarction[J]. Clin Cardiol,2018,41(10):1367-1373.
[22] Pearce SH,Razvi S,Yadegarfar ME,et al. Serum thyroid func-tion,mortality and disability in advanced old age:The newcastle85+study[J]. J Clin Endocrinol Metab,2016,101(11):4385-4394.
[23] Altamirano Ufion A,Zulfiqar B,Hassan A,et al. Subclinicalhypothyroidism and its association with increased cardiovascularmortality[J]. Cardiol Res Pract,2017,2017:7539735.
[2] Ling Y,Jiang J,Gui M,et al. Thyroid function,prevalent coro-nary heart disease,and severity of coronary atherosclerosis in pa-tients undergoing coronary angiography[J]. Int J Endocrinol,2015,2015:708272.
[3] Wang W,Guan H,Gerdes AM,et al. Thyroid status,cardiacfunction,and mortality in patients with idiopathic dilated cardio-myopathy[J]. J Clin Endocrinol Metabol,2015,100(8):3210-3218.
[4] Wang W,Guan H,Fang W,et al. Free triiodothyronine levelcorrelates with myocardial injury and prognosis in idiopathic dilat-ed cardiomyopathy:Evidence from cardiac mri and spect/pet im-aging[J]. Sci Rep,2016,6(39811.
[5] Rothberger GD,Gadhvi S,Michelakis N,et al. Usefulness ofserum triiodothyronine(T3)to predict outcomes in patients hos-pitalized with acute heart failure[J]. American J Cardiol,2017,119(4):599-603.
[6] Hayashi T,Hasegawa T,Kanzaki H,et al. Subclinical hypothy-roidism is an independent predictor of adverse cardiovascular out-comes in patients with acute decompensated heart failure[J].ESC Heart Failure,2016,3(3):168-176.
[7] Okayama D,Minami Y,Kataoka S,et al. Thyroid function onadmission and outcome in patients hospitalized for acute decom-pensated heart failure[J]. J Cardiol,2015,66(3):205-211.
[8] Ziman ME,Bui HT,Smith CS,et al. The pharmacists'role inimproving guideline compliance for thyroid function testing in pa-tients with heart failure[J]. J Pharm Pract,2012,25(2):195-200.
[9] She J,Feng J,Deng Y,et al. Correlation of triiodothyronine lev-el with in-hospital cardiac function and long-term prognosis in pa-tients with acute myocardial infarction[J]. Dis Markers,2018,2018:5236267.
[10] She J,Hu Z,Deng Y,et al. Chest pain after aortic valve re-placement:Rupture of right sinus of valsalva presenting as myo-cardial infarction[J]. Cardiology,2016,134(1):22-25.
[11] Hollander JE,Than M,Mueller C. State-of-the-art evaluation ofemergency department patients presenting with potential acutecoronary syndromes[J]. Circulation,2016,134(7):547-564.
[12]王思远,王文尧,唐熠达.甲状腺功能减退与急性心肌梗死患者不良心血管事件的相关性研究[J].中国循环杂志,2017,32(z1):7.
[13] Vernon ST,Coffey S,Bhindi R,et al. Increasing proportion of stelevation myocardial infarction patients with coronary atheroscle-rosis poorly explained by standard modifiable risk factors[J].Eur J Prevent Cardiol,2017,24(17):1824-1830.
[14] Kidd SK,Bonaca MP,Braunwald E,et al. Universal classifica-tion system type of incident myocardial infarction in patients withstable atherosclerosis:Observations from thrombin receptor antag-onist in secondary prevention of atherothrombotic ischemic events(tra 2 degrees p)-timi 50[J]. J Am Heart Assoc,2016,5(7):pii:e003237.
[15] Prado-Uribe MDC,Ventura MD,Avila-Diaz M,et al. Low triio-dothyronine is associated with elevation of n-terminal pro-brainnatriuretic peptide(nt-probnp)and mortality in dialysis patients[J]. Nefrologia,2017,37(6):598-607.
[16] Mai W,Janier MF,Allioli N,et al. Thyroid hormone receptoralpha is a molecular switch of cardiac function between fetal andpostnatal life[J]. Proc Natl Acad Sci U S A,2004,101(28):10332-10337.
[17] Swanson EA,Gloss B,Belke DD,et al. Cardiac expression andfunction of thyroid hormone receptor beta and its pv mutant[J].Endocrinology,2003,144(11):4820-4825.
[18] Ojamaa K,Kenessey A,Klein I. Thyroid hormone regulation ofphospholamban phosphorylation in the rat heart[J]. Endocrinolo-gy,2000,141(6):2139-2144.
[19]李慧娣,向定成,张金霞,等.急性心肌梗死早期脑钠肽浓度的动态演变规律及其对心力衰竭的诊断价值[J].南方医科大学学报,2018,38(1):112-116.
[20] Li X,Yao Y,Chen Z,et al. Thyroid-stimulating hormone withinthe normal range and risk of major adverse cardiovascular eventsin non-ischemic dilated cardiomyopathy patients with severe leftventricular dysfunction[J]. Clin Cardiol,2018:Epub ahead ofprint.
[21] Seo SM,Koh YS,Park HJ,et al. Thyroid stimulating hormoneelevation as a predictor of long-term mortality in patients with a-cute myocardial infarction[J]. Clin Cardiol,2018,41(10):1367-1373.
[22] Pearce SH,Razvi S,Yadegarfar ME,et al. Serum thyroid func-tion,mortality and disability in advanced old age:The newcastle85+study[J]. J Clin Endocrinol Metab,2016,101(11):4385-4394.
[23] Altamirano Ufion A,Zulfiqar B,Hassan A,et al. Subclinicalhypothyroidism and its association with increased cardiovascularmortality[J]. Cardiol Res Pract,2017,2017:7539735.