血清游离三碘甲状腺原氨酸水平与心脏再同步化治疗患者预后的相关性  

Association of serum free triiodothyronine with long-term outcome in heart failure patients receiving cardiac resynchronization therapy

作　　者：糜家睿[1] 刘志敏[1] 杨绳文 华伟[1] 陈柯萍[1] 丁立刚[1] 张澍[1] 

机构地区：[1]北京协和医学院中国医学科学院阜外心血管病医院国家心血管病中心心血管疾病国家重点实验室心律失常中心,北京100037

出　　处：《中华医学杂志》2015年第48期3903-3907,共5页National Medical Journal of China

基　　金：国家科技支撑计划（2011BAI11B02）

摘　　要：目的 探讨血清游离三碘甲状腺原氨酸（FT3）对接受心脏再同步化治疗（CRT）的心力衰竭（心衰）患者预后的评估价值.方法 回顾性分析阜外医院2010年1月至2014年12月首次行CRT植入的202例心衰患者临床资料和电话随访资料.定义随访终点为全因死亡（包括心脏移植）和心衰再住院.根据入院FT3三分位水平将患者分为FT3≤4.08 pmol/L（67例）、4.09 ～4.71 pmol/L（68例）和＞4.71 pmol/L（67例）3组.Kaplan-Meier法比较各组临床终点情况,单因素和多因素cox回归分析评价FT3水平对临床终点的预测作用.结果 基线数据显示FT3≤4.08 pmol/L组年龄较大,女性患者比例较高,估计肾小球滤过率（eGFR）、血红蛋白、血钠、吸烟史、饮酒史、服用肾素-血管紧张素系统抑制剂比例低,纽约心脏病学会（NYHA）心功能Ⅳ级患者所占比例更高（均P＜0.05）.Kaplan-Meier生存曲线显示FT34.09 ～4.71 pmol/L组全因死亡和心衰再住院发生率最低（P=0.022、0.020）;多因素cox回归分析显示,以FT3≤4.08 pmol/L组为参照,FT34.09 ～4.71 pmol/L是全因死亡（HR =0.220,95％ CI：0.069 ～0.700,P-0.011）和心衰再住院（HR=0.490,95％ CI：0.241～0.996,P=0.049）的独立保护因素;左室舒张末内径（HR=1.043,95％ CI：1.004 ～1.083,P=0.031）是全因死亡的独立危险因素.结论 FT3 4.09～4.71 pmol/L的CRT患者全因死亡和心衰再住院风险最低.Objective To explore the prognostic role of free triiodothyronine （FT3） on all-cause mortality and heart failure （HF） hospitalization in patients receiving cardiac resynchronization therapy （CRT）.Methods In this single-center retrospective cohort study,a total of 202 chronic heart failure （CHF） patients who had CRT implantation from January 2010 to December 2014 were enrolled.Clinical outcomes were defined as all-cause mortality （including heart transplantation） and new heart failure （HF） hospitalization.Patients were divided into three groups according to FT3 tertiles：FT3 ≤ 4.08 pmol/L group （n=67）,FT3 4.09-4.71 pmol/L group （n =68） and FT3 〉 4.71 pmol/L group （n =67）.Kaplan-Meier analyses were performed for each outcome.Cox proportional-hazards regression analyses were used to evaluate the independent prognosis of FT3 in CRT treated patients.Results Patients in FT3 ≤ 4.08 pmol/L group tended to be older,with more women patients,and had lower estimated glomerular filtration rate （eGFR）,hemoglobin and serum sodium concentration.They were also less frequently subjected to smoking,alcohol consumption and were less likely prescribed with renin-angiotensin-aldosterone system inhibitors.Also,this group had highest proportion of NYHA class Ⅳ patients.Kaplan-Meier analyses demonstrated that FT3 4.09-4.71 pmol/L group was associated with a significantly better survival （P =0.022） and less new hospitalizations for HF event （P =0.020）.Cox regression analyses indicated that FT3 4.09-4.71 pmol/L was an independent protective factor for both all-cause mortality （HR =0.220,95% CI：0.069-0.700,P =0.011） and HF hospitalization （HR =0.490,95% CI：0.241-0.996,P =0.049）.Left ventricular end diastolic diameter （LVEDd） enlargement was an independent risk factor of all-cause mortality （HR =1.043,95 % CI：1.004-1.083,P =0.031）.Conclusion Patients in FT3 4.09-4.71 pmol/L group had the lowest risk of all-cause mortality and HF hospitalization after CRT implantat

关 键 词：三碘甲状腺原氨酸 心力衰竭 心脏再同步治疗 危险因素 预后 

分 类 号：R541.6[医药卫生—心血管疾病]