甲状腺激素对急性ST段抬高型心肌梗死合并急性心力衰竭患者预后的研究  

Effect of thyroid hormone on the prognosis of patients with acute heart failure complicated with acute ST elevated myocardial infarction

作　　者：薛增明[1] 杨彦立[1] 安巨会[1] 刘新民[2] 张崟[2] 聂绍平[2] 马长生[2] 

机构地区：[1]河北省廊坊市人民医院心内一科,065000 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科

出　　处：《心肺血管病杂志》2015年第7期533-536,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的：探讨低三碘甲腺原氨酸（T3）综合征,对合并心力衰竭的急性心肌梗死患者预后的影响。方法：前瞻性连续纳入行急诊经皮冠状动脉介入治疗（PCI）的急性ST段抬高心肌梗死（STEMI）同时合并急性心力衰竭患者246例,按照是否合并低T3综合征分为两组：低T3综合征组（n=50）和甲状腺功能正常组（n=196）。分别评价患者住院期间的临床、血管造影及超声心动图等相关资料并对患者进行长期随访。平均随访时间为367天,一级终点为全因病死率。结果：在随访期间两组患者在再次血运重建（P=0.037）、新发心力衰竭（P=0.016）和主要不良心脏事件发生率方面（P=0.013）差异有统计学意义。在总病死率方面两组差异无统计学意义（P=0.278）。通过使用Cox比例风险回归分析,发现游离T3水平（HR=0.813,95%：CI：0.725~0.854,P=0.003）是影响患者发生死亡独立的预测因子。结论：行直接PCI的STEMI合并心力衰竭患者,和甲状腺功能正常的患者相比,合并低T3综合征患者具有较高的主要不良心脏事件发生率,但二者长期病死率相似;患者游离T3水平是影响患者死亡的独立预测因素。Objective： To study the effect of thyroid hormone on acute heart failure with acute ST elevated myocardial infarction. Methods： This was a single-center prospective study of 246 patients with acute heart failure and documented acute ST elevated myocardial infarction. All patients were treated with primary PCI. We assessed clinical,angiographic and echocardiographic characteristics,and prognosis after PCI in those with low T3 syndrome or normal thyroid hormone. Heart failure patients were divided into two groups： 59 with low T3 syndrome and 196 with normal thyroid hormone. The average follow-up was 367 days; the primary outcome,death. Results： 2（ 4. 0%） patients in the low T3 syndrome group vs. 2（ 1. 02%） in the normal thyroid hormone group died. The difference between the groups was not significant（ P = 0. 278）. Main adverse cardiac events（ MACE） during follow-up had significant difference between the two groups（ P = 0. 013）. FT3（ HR 0. 813,95% CI 0. 725 ~ 0. 854,P = 0. 003） was significantly related to the death rate during follow-up.Conclusions： Factor affecting prognosis in acute heart failure patients with low T3 syndrome after coronary revascularization was FT3 level. Patients with low T3 syndrome may have a similar prognosis after primary stenting than those with normal thyroid hormone.

关 键 词：甲状腺功能 急性心肌梗死 心力衰竭 血运重建 

分 类 号：R54[医药卫生—心血管疾病]