非甲状腺综合征对急性心力衰竭患者院内结局的影响  

Effect of nonthyroidal illness syndrome on hospital outcome in patients with acute heart failure

作　　者：汪瑞[1] 董天赋[1] 沈俊[1] 李淑琴[1] 黄韬 王莹[1] 康秀文[1] Wang Rui;Dong Tian -fu;Shen Jun;Li Shu - qin;Huang Tao;Wang Ying;Kang Xiu - wen.(Department of Breast and Thyroid, the First People＇s Hospital of Lianyungang City, Lianyungang 222000, Chin)

机构地区：[1]连云港市第一人民医院甲乳外科,江苏连云港222000

出　　处：《中国急救医学》2018年第4期314-319,共6页Chinese Journal of Critical Care Medicine

摘　　要：目的 评价急性心力衰竭（AHF）患者入院游离三碘甲腺原氨酸（FT3）水平与患者院内结局的相关性。方法 选取在我院心内科重症监护病房治疗的189例HF患者，在患者入院后第1天与第7天检测患者血清FT3指标，根据患者是否患有非甲状腺疾病综合征（NTIS）将患者分为低FT3组（n=91）与正常FT3（n=98）组，比较两组患者的临床资料与院内结局，采用多元线性回归模型评价患者住院时间与其他变量的相关性。采用Logistic回归分析评价患者住院时间的独立相关因素。结果 患者入院FT3水平与患者住院时间呈负相关（R=-0.590，P=0.013）。与正常FT3组患者比较，低FT3组患者住院时间［12（8，25）d vs.8（7，20）d，Z=5.268，P＜0.001］与有创机械通气患者比例［8.8%（8/91）vs. 2.0%（2/98），χ2=28.841，P＜0.001］均显著增加。低FT3组与正常FT3组病死率比较差异无统计学意义［2.2%（2/91）vs. 0，χ2=1.154，P=0.283］。入院FT3水平与患者住院时间独立相关［OR=0.617，95%CI 0.494～0.770，P＜0.001］。入院第7天，25例低FT3组患者T3恢复正常（T3恢复组，n=25），与66例T3未恢复（T3未恢复组，n=66）患者比较，T3恢复组患者住院时间、有创机械通气患者比例、再入院患者比例均显著降低（P均＜0.05）。结论 低T3水平预示着急性HF患者较差的院内结局，而低T3水平恢复正常可以显著改善患者院内结局。Objective To evaluate the correlation between the level of free serum triiodothyronine（ FT3 ） in hospitalized patients with acute heart failure （HF） and the outcome of patients in hospital. Methods A total of 189 HF patients who were treated in the intensive care unit of Department of Cardiology in our hospital were selected. On the first day and the seventh day after admission, the patients＇ serum FT3 indexes were detected. The patients were divided into the low FT3 group（ n = 91 ） and the normal FT3 group（ n = 98） according to whether the patients had the nonthyroidal illness syndrome （NTIS）. The clinical data of the two groups and the outcome of the hospital were compared. The multivariate linear regression model was used to evaluate the correlation between patients＇ hospitalization time and other variables. Logistic regression analysis was used to evaluate the independent factors of the patient＇s time of hospitalization. Results The admission FT3 levels was negatively correlated with the patient＇s length of stay （ R = - 0. 590, P = 0. 013 ）. Compared with the normal FT3 group, the hospitalization time[12（8, 25）d vs. 8（7, 20）d, Z =5.268, P 〈0.001] and the percentage of patients with invasive mechanical ventilation [ 8.8% （ 8/91 ） vs. 2.0% （ 2/98 ）, X2 = 28. 841, P 〈 0. 001 ] in the low FT3 group were significantly increased. There was no statistically significant difference in mortality between the low FT3 group and the normal FT3 group [2.2% （2/91） vs. 0, X2 = 1. 154, P = 0. 283 ]. The level of FT3 was independent of the patient＇s hospitalization time [ OR = 0. 617, 95% CI 0. 494 - 0. 770, P 〈 0. 001 ]. On the 7th day after admission, the T3 index of 25 patients with low FT3 returned to normal （T3 recovery group, n = 25 ）. Compared with 66 patients without T3 recovery （T3 non - recovery group, n = 66）, the hospitalized time, the proportion of patients with invasive mechanical ventilation, the proportion of patients admitted to hospital in T3

关 键 词：心力衰竭 非甲状腺综合征 游离三碘甲腺原氨酸(FT ) 

分 类 号：R733.7[医药卫生—肿瘤]