老年慢性心力衰竭患者甲状腺激素、氨基末端脑钠肽前体变化及其对预后的评估价值  

Changes of Thyroid Hormones and NT-pro BNP and the Estimated Value on Prognosis of Elderly Patients With Chronic Heart Failure

作　　者：刘建飞[1] 彭宗清[1] 夏豪[2] 

机构地区：[1]湖北省襄阳市中心医院北区,441000 [2]武汉大学人民医院

出　　处：《实用心脑肺血管病杂志》2016年第1期7-11,共5页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：国家自然科学基金资助项目(81270184);湖北省医学会中青年扶持计划(HW-2009BNO.018)

摘　　要：目的分析老年慢性心力衰竭(CHF)患者甲状腺激素、氨基末端脑钠肽前体(NT-pro BNP)变化及其对预后的评估价值。方法选取2012年5月—2015年2月在襄阳市中心医院心内科住院的老年CHF患者120例作为CHF组,其中心功能Ⅱ级42例,心功能Ⅲ级47例,心功能Ⅳ级31例。另选取同期在本院体检健康的老年人120例作为对照组。比较两组受试者及不同心功能分级CHF患者血浆甲状腺激素〔三碘甲状腺原氨酸(T3)、甲状腺素(T4)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)〕、NT-pro BNP水平及左心室射血分数(LVEF),并分析CHF患者血浆NT-pro BNP水平及LVEF与血浆甲状腺激素水平的相关性。根据CHF患者住院期间心血管事件发生情况分为心血管事件组42例和非心血管事件组78例,比较心血管事件组与非心血管事件组患者血浆甲状腺激素、NT-pro BNP水平及LVEF。结果 CHF组与对照组受试者血浆T4、FT4、TSH水平比较,差异无统计学意义(P>0.05);CHF组患者血浆T3、FT3水平及LVEF低于对照组,血浆NT-pro BNP水平高于对照组(P<0.05)。不同心功能分级CHF患者血浆T4、FT4、TSH水平比较,差异无统计学意义(P>0.05);心功能Ⅲ级患者血浆FT3水平低于心功能Ⅱ级患者,血浆NT-pro BNP水平高于心功能Ⅱ级患者(P<0.05);心功能Ⅳ级患者血浆T3、FT3水平及LVEF低于心功能Ⅱ、Ⅲ级患者,血浆NT-pro BNP水平高于心功能Ⅱ、Ⅲ级患者(P<0.05)。Pearson相关性分析结果显示,血浆NT-pro BNP水平与血浆T3、FT3水平呈负相关(r值分别为-0.335、-0.221,P<0.05),与血浆T4、FT4、TSH水平无直线相关性(r值分别为0.047、0.027、0.015,P>0.05)。LVEF与血浆T3、FT3水平呈正相关(r值分别为0.410、0.229,P<0.05),与血浆T4、FT4、TSH水平无直线相关性(r值分别为0.085、0.087、0.004,P>0.05)。心血管事件组与非心血管事件组患者血浆T4、FT4、TSH水平比较,差异无统计学意义(P>0.05Objective To analyze the changes of thyroid hormones and NT-pro BNP and the estimated value on prognosis of elderly patients with chronic heart failure（ CHF）. Methods A total of 120 elderly patients with CHF were selected as case group in the Xiangyang Centeral Hospital from May 2012 to February 2015,including 42 cases with Ⅱ- grade cardiac function（ served as A group）,47 cases with Ⅲ- grade cardiac function（ served as B group）,31 cases with Ⅳ- grade cardiac function（ served as C group）; a total of 120 healthy old people admitted to this hospital for physical examination were selected as control group at the same time. Plasma levels of thyroid hormones（ including T3,T4,FT3,FT4,TSH） and NT-pro BNP,and LVEF were compared between case group and control group, in patients with different cardiac functional grading, and correlations between plasma levels of thyroid hormones and plasma NT-pro BNP level,and LVEF were analyzed. According to the incidence of cardiovascular events,patients of case group were divided into D group（ complicated with cardiovascular events,n= 42） and E group（ did not complicated with cardiovascular events, n = 78）, plasma levels of thyroid hormones and NT-pro BNP,and LVEF were compared between D group and E group. Results No statistically significant differences of plasma level of T4,FT4 or TSH was found between case group and control group（ P〈0. 05）; plasma levels of T3 and FT3,and LVEF of case group were statistically significantly lower than those of control group,while plasma NT-pro BNP level of case group was statistically significantly higher than that of control group（ P〈0. 05）. No statistically significant differences of plasma level of T4,FT4 or TSH was found among A,B and C groups（ P〈0. 05）; plasma FT3 level of B group was statistically significantly lower than that of A group,while plasma NT-pro BNP level of B group was statistically significantly higher than that of A group（ P〈0. 05）; plasma levels of T3 and FT3,and LVEF of C

关 键 词：心力衰竭 甲状腺激素类 氨基末端脑钠肽前体 预测 

分 类 号：R541.6[医药卫生—心血管疾病]