血清总T3和游离T4水平与急性心肌梗死后心力衰竭发生的相关性研究  

Correlation between serum total T3 and free T4 levels and heart failure after acute myocardial infarction

作　　者：李明亮[1] 陈强 LI Mingliang;CHEN Qiang(Department of Cardiology, Hanzhong People＇s Hospital, Hanzhong, 723000, Chin)

机构地区：[1]汉中市人民医院心血管内科,陕西汉中723000

出　　处：《临床心血管病杂志》2018年第4期338-342,共5页Journal of Clinical Cardiology

摘　　要：目的:探讨血清总三碘甲状腺氨酸(T3)、游离甲状腺素(fT4)及其比值在预测急性心肌梗死(AMI)患者经皮冠状动脉介入术(PCI)后继发心力衰竭(heart failure,HF)的临床价值。方法:回顾性分析2007-01—2015-12我科收治的404例AMI行急诊PCI患者的一般治疗、行PCI前的血清生化标志物、超声心动图、冠状动脉造影等临床资料,以及PCI后1年内的心脑血管不良事件的发生情况,尤其是因HF再入院治疗的发生率,并根据有无因HF再入院治疗将患者分为HF组和非HF组。通过组间比较、受试者工作特征曲线(ROC曲线)、logistics回归分析等评估血清总T3、fT4及其比值与HF再入院发生率的相关性。结果:404例AMI患者中,18例患者(4.5%)在PCI治疗后12个月内因HF再次入院治疗。HF组的血清总T3水平低于非HF组[(84.3±21.0)ng/dl∶(101.2±20.4)ng/dl,P<0.001],而fT4水平高于非HF组[(1.44±0.26)ng/dl∶(1.23±0.22)ng/dl,P<0.001],并且HF组的总T3/fT4值低于非HF组(58.39±21.35∶124.54±24.07,P<0.001)。血清总T3水平、总T3/fT4值在ROC曲线下面积分别为0.763和0.795,其诊断阈值分别为81.19ng/dl和67.46。在多因素logistics回归分析中,总T3/fT4值降低是AMI患者PCI治疗1年内发生HF的独立预测因子(OR=0.976,95%CI:0.964~0.989,P<0.001)。结论:AMI后总T3水平的降低与PCI治疗后1年内HF的发生密切相关,总T3/fT4值<67.46是预测HF发生的良好指标。Objective：To investigate the predictive value of serum total T3,free T4（fT4）and their ratio in the ouccurance of heart failure（HF）after acute myocardial infarction（AMI）treated with percutaneous coronary intervention（PCI）.Method：This study retrospectively enrolled 404 cases of AMI patients treated with PCI during January 2007 to December 2015 in our department.The baseline characteristics of serum biochemical markers,echocardiography and coronary angiography results,and 1 year major adverse cardiovascular and cerebrovascular events,especially for HF requiring re-hospitalization,were collected.All patients were subgrouped into HF group and nonHF group based on the occurrence of HF requiring re-hospitalization.The correlation between the total serum T3,fT4 and its ratio and the incidence of HF requiring re-hospitalization statistically analyzed by comparing the groups,the receiver operating characteristic curve,and the logistics regression analysis.Result：Among the 404 patients with AMI,18 patients（4.5%）were rehospitalized within 12 months to control HF symptoms.The serum total T3 levels in HF group were significantly lower than non-HF group [（84.3±21.0）ng/dl vs（101.2±20.4）ng/dl,P〈0.001],the fT4 levels were higher than that of non-HF group[（1.44±0.26）ng/dl vs（1.23±0.22）ng/dl,P〈0.001],and the total T3/fT4 ratio in HF group were lower than that of non-HF patients（58.39±21.35 vs 124.54±24.07,P〈0.001）.The area under ROC curve for serum total T3 level and the total T3/fT4 ratio were 0.763 and 0.795 respectively,and the diagnostic thresholds were 81.19 ng/dl and 67.46 for total T3 level and the total T3/fT4 respectively.In the multivariate logistic regression analysis,the lower total T3/fT4 ratio was an independent predictor of HF requiring re-hospitalization within a year of AMI patients after PCI treatment（OR=0.976,95%CI：0.964-0.989,P〈0.001）.Conclusion：The decrease of total T3 levels after AMI were well correlated with 1 year HF in patients treated with

关 键 词：急性心肌梗死 心力衰竭 血清总T3 游离T4 总T3/fT4值 

分 类 号：R542.2[医药卫生—心血管疾病]