非甲状腺病态综合征和急性心肌梗死的临床研究  

A clinical study of acute myocardial infarction with non-thyroid sick syndrome

作　　者：高婧[1] 任颖[1] 魏盟[2] 王俊薇 赵催春[1] 杜冬梅[1] 

机构地区：[1]上海交通大学附属第六人民医院特需医疗科上海市糖尿病临床医学中心,200233 [2]上海交通大学附属第六人民医院心内科,200233

出　　处：《中华内分泌代谢杂志》2013年第11期925-930,共6页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的本研究通过检测急性心肌梗死（AMI）患者入院血游离三碘甲状腺原氨酸（FL）水平，探讨非甲状腺病态综合征（non—thyroidsicksyndrome，NTIS）与AMI近期和远期死亡率的关系。方法人选1019例新诊断AMI患者，根据入院24h内血Fr，四分位数（Quartile）水平分成1～4组：生存组和死亡组：甲状腺功能正常组和NTIS组。随访6～90个月，中位随访时间为44．5个月，采用logistic逐步回归和Cox比例风险模型，比较NTIS和FT，水平对AMI近期及远期死亡的相关关系。结果NTIS发病率占AMI患者的27．78％。随着FT，的降低和FL／F．rd比值的降低，全因死亡率逐渐增高（Quartile1组为9．4％，Quartile2组为13．8％，Quartile3组为14．3％，Quartile4组为34．0％，P〈0．01）。经过校正，Frrl（RR=0．212，95％C10．125～0．359）为30d内死亡最强的影响因素。多因素Cox回归分析显示FT，（RR=0．674，95％C10．514～0．885）与长期全因死亡独立相关。Kaplan—Meier显示Quartiled组与Quartile1．3组比较死亡率差异有统计学意义。即使FL水平在正常范围低值，也与心梗全因死亡相关。结论NTIS在AMI患者中常见。经过校正后FL是30d短期死亡的最强预测因子，低FT，水平是影响AMI患者远期全因死亡率的独立危险因素，同时显示即使FL水平在正常范围低值，仍与AMI全因死亡相关。Objective The prognosis of patients with acute myocardial infarction （ AMI ） is related to age, eomorbidities, and other factors, in which non-thyroid sick syndrome （NTIS） may also be an important factor. In this study, determination of blood free triiodothyronine （ FT3 ） was used to explore the short-term and long-term mortality relationship of NTIS with acute myocardial infarction. Methods A total of 1 019 cases of newly diagnosed patients with acute myocardial infarction were enrolled. According to FF3 levels, the enlisted subjects were divided into Quartile 1-4 groups; survival group and non-survival group; normal thyroid function and NTIS group. The enrolled subjects were followed-up for 6-90 months, with the median follow-up time of 44.5 months. Using logistic regression and Cox hazards model, the relationships of short-term and long-term mortality in AMI with NTIS or FT3 were compared. Results The incidence of NTIS in patients with AMI was 27.78%. With the progressively decreasing FT3 and FT3/FT4 ratio, the mortality rates were progressively increased （ Quartile 1 group 9.4% , Quartile 2 group 13.8%, Quartile 3 group 14.3%, Quartile 4 group 34.0%, P〈0.01 ）. After being adjusted, FT3 was the strongest influencing factor of mortality within 30 days （ RR = 0. 212, 95% CI O. 125-0. 359 ）. Multivariate Cox regression analysis showed that FF3 was independently associated with long-term mortality （RR = 0. 674, 95% CI 0. 514- 0. 885）. Kaplan-Meier showed significant difference in mortality between quartile 1-3 groups and the Quartile 4 group. Even FT3 level was within the low normal range, it was related with the mortality in AMI. Conclusions NTIS is common in patients with AMI. After being adjusted, FT3 was the strongest predictor of mortality within 30 days, and low FT3level in AMI patients was an independent risk factor for long-term all-cause mortality. Even FT3 level was within the normal range, it was still related with mortality in myocardial infarction.

关 键 词：游离三碘甲状腺原氨酸 心肌梗死 远期随访 

分 类 号：R542.22[医药卫生—心血管疾病]