急性心力衰竭患者血清游离T4和总T3与心力衰竭再入院的相关性  

Correlation between readmission for heart failure and serum free thyroxine and total triiodothyronine levels in patients with acute heart failure and

作　　者：单联斌 王超 刘晓红 Shan Lianbin;Wang Chao;Liu Xiaohong(Jiaozhou People's Hospital,Jiaozhou 266300,China;Jiaozhou Maternal and Child Health Care Hospital,Jiaozhou 266300,China;Qingdao Jiaozhou Central Hospital,J iaozhou 266300,China)

机构地区：[1]山东省胶州市人民医院,266300 [2]胶州市妇幼保健院,266300 [3]青岛市胶州中心医院,266300

出　　处：《中国实用医刊》2018年第23期35-39,共5页Chinese Journal of Practical Medicine

摘　　要：目的分析急性心肌梗死(AMI)患者血清游离甲状腺素(fT4)与总三碘甲状腺原氨酸(tT3)水平与发生心力衰竭(HF)再入院的相关性。方法选取2014年7月至2018年6月胶州市人民医院收治的646例AMI患者,根据患者是否发生HF分为HF组(n=58)与非HF组(n=588)。比较两组患者的临床资料,采用受试者工作曲线(ROC)分析相关指标的阈值,采用ROC曲线下面积(AUC)评价这些指标的诊断价值,采用kaplan-meier曲线比较组间累积生存率,采用多N素Logistics回归分析评价相关指标的预测价值。结果ROC曲线分析表明,tT=3诊断HF的AUC为0.764,cut-off值为81.2ng/dl,灵敏度为85.6%,特异度为61.3%。tT3/fT4诊断HF的AUC为0.793,cut-off值为67.5ng/dl,灵敏度为77.6%,特异度为72.3%。以上结果提示,tT3/fT4诊断HF的价值优于tT3。低tT3/fT4(tT3/fT4<67.5)组HF再入院患者比例高于高tT3/fT4(tT3/fT4≥67.5)组(13.0%比1.4%,x^2=39.227,P<0.001)。多因素Logistics回归分析表明,低左室射血分数(OR=0.802,95%CI:0.782~0.824,P=0.011)、低tT3/fT4(OR=0.977,95%CI:0.965~0.990,P=0.032)与高B型脑钠肽(OR=3.011,95%CI:1.913~5.679,P=0.025)是患者HF再入院的独立危险因素。结论行经皮冠状动脉介入治疗的AMI患者tT3水平降低与患者HF再入院密切相关,tT3/fT4<67.5是预测患者HF再入院的良好指标。Objective To evaluate the correlation between serum free thyroxine (fT4)and total triiodothyronine (tT3)levels in patients with acute myocardial infarction (AMI)and re-admission for heart failure (HF).Methods A total of 646AMI patients admitted to Jiaozhou People's Hospital from July 2014 to June 2018 were selected,and patients were divided into HF group (n=58)and non-HF group (n=588)according to HF development.The clinical data of the two groups were compared.The receiver operating curve (ROC)was used to analyze the threshold of the relevant indicator.The area under the ROC curve (AUC)was used to evaluate the diagnostic value o[these indicators.The kaplanmeier curve was used to compare the cumulative survival rate between the two groups.Multivariate logistic regression analysis was used to evaluate the predictive value of relevant indicators.Results ROC curve analysis showed that the AUC value of tT3 in diagnosis of HF was 0.764,the cut-off value was 81.2ng/dl,the sensitivity was 85.6%,and the specificity was 61.3%.The AUC value of tT3/fT4 in diagnosis of HF was 0.793,the cut-off value was 67.5ng/dl,the sensitivity was 77.6%,and the specificity was 72.3%.The above results suggest that tT3/fT4 was superior to tT3 in the diagnosis of HF.The proportion of HF readmission patients in low tT3/fT4(tT3/fT4<67.5)group was significantly higher than that in high tT3/tT4(tT3/fT4>67.5)group (13%vs.1.4%,x^2=39.227,P<0.001). Multivariate logistic regression analysis showed low left ventricular ejective fraction(LVEF)(OR=0.802, 95%CI:0.782-0.824,P=0.011),low tT3/fT4(0R=0.977,95% CI:0.965-0.990,P=0.032)and high BNP (OR=3.011,95%CI:1.913-5.679,P=0.025)were independent risk factors of HF readmission.Conclusions The decrease in tT3levels in patients with AMI undergoing PCI is closely related to the re-admission of patients with HF.tT3/fT4<67.5is a good indicator for predicting HF re-admission.

关 键 词：心力衰竭 游离 甲状腺素 总三碘甲状腺氨酸 相关性 

分 类 号：R541.6[医药卫生—心血管疾病]