游离三碘甲腺原氨酸/游离甲状腺素比值对住院心力衰竭患者预后的影响  

The prognostic value of free triiodothyronine/free thyroxine ratio in patients hospitalized with heart failure

作　　者：周萍 黄丽燕 翟玫[1] 黄燕[1] 庄晓峰[1] 刘慧慧[1] 张宇辉[1] 张健[1] Zhou Ping;Huang Liyan;Zhai Mei;Huang Yan;Zhuang Xiaofeng;Liu Huihui;Zhang Yuhui;Zhang Jian(Heart Failure Center,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院,国家心血管病中心,阜外医院,国家心血管疾病重点实验室,心力衰竭中心,北京100037

出　　处：《中华医学杂志》2023年第22期1679-1684,共6页National Medical Journal of China

基　　金：国家科技重大专项(2017YFC1308300)

摘　　要：目的探讨游离三碘甲腺原氨酸(FT3)/游离甲状腺素(FT4)比值对心力衰竭(心衰)患者预后的影响。方法回顾性分析2009年3月至2018年6月在中国医学科学院阜外医院心衰中心住院的3527例心衰患者的临床资料。根据FT3/FT4比值的中位数分为低FT3/FT4比值组(1764例,FT3/FT4<2.15)和高FT3/FT4比值组(1763例,FT3/FT4≥2.15)。收集患者临床资料,患者出院后进行系统的门诊复查或电话随访,研究主要终点定义为全因死亡或心脏移植或植入左心室辅助装置的复合终点。比较基线时不同FT3/FT4比值组患者临床资料差异,采用多因素Cox比例风险回归模型分析FT3/FT4比值与住院心衰患者预后的相关性。结果3527例患者的年龄为(56.8±16.0)岁,男性为2544例(72.1%);随访时间[M(Q 1,Q 3)]为2.79(1.00,5.03)年,最终随访时共记录了1542例患者的终点事件。低FT3/FT4比值组和高FT3/FT4比值组患者的年龄分别为(58.8±16.5)和(54.8±15.2)岁(P<0.001),随访期间累积生存率分别为38.4%、61.9%(P<0.001)。FT3(HR=0.72,95%CI:0.63~0.84,P<0.001)、FT3/FT4比值(HR=0.76,95%CI:0.65~0.87,P<0.001)是心衰患者全因死亡、心脏移植或植入左心室辅助装置复合终点的相关因素;FT3/FT4比值预测左心室射血分数(LVEF)为<40%、40%~49%、≥50%患者复合终点风险的HR值(95%CI)分别为0.91(0.77~1.08),0.83(0.50~1.39),0.65(0.50~0.85)(P交互=0.045)。结论低FT3和低FT3/FT4比值是住院心衰患者不良预后的相关因素;在LVEF≥50%患者中FT3/FT4比值具有更显著的预测作用。Objective To investigate the effect of free triiodothyronine/free thyroxine(FT3/FT4)ratio on the prognosis of patients with heart failure(HF).Methods A total of 3527 patients hospitalized in the Heart Failure Center of Fuwai Hospital from March 2009 to June 2018 were analyzed in our study.Patients were divided into two groups according to median of FT3/FT4 ratio:low FT3/FT4 group(n=1764,FT3/FT4<2.15)and high FT3/FT4 group(n=1763,FT3/FT4≥2.15).The primary endpoint was defined as a composite endpoint of all-cause death or heart transplantation or implantation of a left ventricular assist device.The baseline characteristics of patients with different FT3/FT4 ratio groups were compared,and a multivariate Cox proportional hazard regression model was used to analyze the relationship between FT3/FT4 ratio and the prognosis of hospitalized patients with HF.Results The age of the total population was(56.8±16.0)years,and 2544 cases(72.1%)were males.The median follow-up time was 2.79(1.00,5.03)years,and a total of 1542 end-point events were recorded at the final follow-up.The mean ages of patients in the low FT3/FT4 group and high FT3/FT4 group were(58.8±16.5)and(54.8±15.2)years(P<0.001),respectively;and the cumulative survival rates were 38.4%and 61.9%,respectively(P<0.001).FT3(HR=0.72,95%CI:0.63-0.84,P<0.001),FT3/FT4(HR=0.76,95%CI:0.65-0.87,P<0.001)was associated with all-cause death,heart transplantation,or LVAD implantation in patients with heart failure.HR values(95%CI)of FT3/FT4 ratio predicting the risk of composite endpoint in the subgroup of left ventricular ejection fraction(LVEF)<40%,40%to 49%,and≥50%were 0.91(0.77-1.08),0.83(0.50-1.39),and 0.65(0.50-0.85),respectively(P interaction=0.045).Conclusions Low FT3 and low FT3/FT4 are important correlative factors for poor prognosis in hospitalized HF patients,especially in patients with LVEF≥50%.

关 键 词：心力衰竭 游离三碘甲腺原氨酸/游离甲状腺素 甲状腺激素 预后 

分 类 号：R541.6[医药卫生—心血管疾病]