游离三碘甲状腺原氨酸与冠状动脉钙化及心血管事件的关系  

Relationship of serum free T3 with the coronary artery calcification and major adverse cardiac events in patients with suspected coronary artery disease

作　　者：朱利杰[1] 高传玉[1] 王宪沛[1] 齐大屯[1] 张优 李牧蔚[1] 刘伟利[1] 都培远[1] 

机构地区：[1]郑州大学人民医院心血管内科,450003 [2]河南省心血管流行病学研究中心

出　　处：《中华心血管病杂志》2014年第12期1017-1021,共5页Chinese Journal of Cardiology

摘　　要：目的 研究血游离三碘甲状腺原氨酸（FT3）与冠状动脉钙化程度的相关性以及对主要心血管事件发生的影响.方法 回颐性分析577例可疑冠心病的门诊患者,均行冠状动脉双源CT和FT3检测,对所有符合入选标准的患者进行随访（8～29个月）,记录主要不良心血管事件（MACE,包括死亡、心肌梗死、冠状动脉支架置入术、冠状动脉旁路移植术）的发生.根据患者FT3水平分为低FT3组（n=126）和正常FT3组（n=451）;根据患者冠状动脉钙化积分（CACS）分为CACS＞ 100组（n =235）和CACS≤100组（n =342）.采用Kaplan-Meier进行生存率分析,logistic回归（逐步法）分析冠状动脉钙化和MACE的相关因素.结果 低FT3组（FT3＜3.5 pmol/L）的冠状动脉钙化负荷[146.7（55.8,599.1）比34.8（0,261.9）,P＜0.001]和MACE发生率明显高于正常FT3组[7.9％（10/126）比2.0％（9/451）,P=0.003];logistic回归（逐步法）分析显示FT3水平与冠状动脉钙化程度有关（OR=0.442,95％ CI =0.317～0.618,P＜0.001）;Kaplan-Meier分析显示低FT3组患者累积生存率明显低于正常FT3组,差异有统计学意义（P=0.005）,CACS＞ 100组患者累积生存率明显低于CACS≤100组患者,差异有统计学意义（P ＜0.001）.结论 血FT3水平是冠状动脉钙化程度和MACE发生的重要影响因素,而且低FT3水平是心血管事件发生的危险因素;冠状动脉钙化程度越重,越易发生心血管事件.Objective To survey the association of serum free triiodothyronine （FT3） level with coronary artery calcification and major adverse cardiac events （MACE） in outpatients with suspected coronary artery disease （CAD）.Methods A total of 577 outpatients with suspected CAD,who underwent dual-source computed tomography and FT3 detection were included,patients were followed up for 8-29 months for the major adverse cardiac events （death,MI,PCI,CABG）.These patients were divided into low FT3 （＜3.5 pmol/L,n =126） and normal FT3 （≥3.5 pmol/L,n =451） group based on the FT3 level,and divided into CACS ＞ 100 （n =235） and CACS ≤ 100 （n =342） group based on the coronary artery calcium score （CACS）.Related factors to CACS and MACE were analyzed using logistic regression （stepwise） analysis.Results CACS （146.7（55.8,599.1） vs.34.8（0,261.9）,P＜0.001） and MACE （7.9％ （10/126） vs.2.0％ （9/451）,P =0.003） were significantly higher in the low FT3 group than in normal FT3 group.Logistic regression analysis demonstrated that the FT3 levels are inversely associated with the CACS （OR =O.442,95％ CI =0.317-0.618,P ＜ 0.001）.Kaplan-Meier analysis displayed that patients with low FT3 levels had a lower cumulative survival rate than patients with normal FT3 levels （P =0.005）,and patients with CACS ＞ 100 also had a lower cumulative survival rate than patients with CACS≤ 100（P ＜ 0.001）.Conclusions FT3 levels are associated with coronary artery calcification scores and the incidence rate of MACE in patients with suspected coronary artery disease.A low FT3 level is considered as an important risk factor of high calcification scores and MACE.

关 键 词：冠状动脉疾病 三碘甲状腺原氨酸 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]