亚临床甲状腺功能减退对老年心力衰竭病人预后的影响  

Effect of subclinical hypothyroidism on prognosis of elderly patients with heart failure

作　　者：刘凯[1] 陈英[2] 郑杨 李文安[1] 候晓晓 张波[1] 仝珊[1] LIU Kai;ZHENG Yang;LI Wen-an;HOU Xiao-xiao;ZHANG Bo;TONG Shan;CHEN Ying(Department of Geriatrics,Hainan General Hospital,Haikou 570311,China;Department of Clinical Laboratory,Hainan General Hospital,Haikou 570311,China)

机构地区：[1]海南省人民医院老年病科,海南省海口市570311 [2]海南省人民医院检验科,海南省海口市570311

出　　处：《实用老年医学》2019年第11期1108-1112,共5页Practical Geriatrics

摘　　要：目的探讨亚临床甲状腺功能减退对老年心力衰竭(HF)病人预后以及潜在的血流动力学和运动能力的影响。方法连续检测1100例60岁以上的HF病人血清促甲状腺激素(TSH)和游离甲状腺素(FT4)水平,比较甲状腺功能正常者(正常组)和亚临床甲状腺功能减退者(亚甲减组)的超声心动图、心肺运动试验和心导管检查的参数,随访研究2组的心脏事件发生率和全因死亡率并分析其影响因素。结果2组间超声心动图参数差异无统计学意义,亚甲减组的呼吸耗氧量低于正常组[峰值耗氧量14.0 VS.15.9 mL/(min·kg);P=0.012],平均肺动脉压高于正常组。在Kaplan-Meier生存曲线图(平均1098 d)中,亚甲减组的心脏事件发生率和全因死亡率显著高于正常组(P<0.01)。在多因素Cox比例风险模型中,亚临床甲减是HF病人心衰恶化和全因死亡的不良预测因子(P均<0.05)。结论在老年HF病人中,亚临床甲状腺功能减退可能与不良预后相关,并伴随运动能力受损和肺动脉压升高。Objective To investigate the effects of subclinical hypothyroidism on prognosis and potential hemodynamics and exercise capacity in the elderly patients with heart failure(HF).Methods Serum thyroid stimulating hormone(TSH)and free thyroxine(FT4)levels in 1100 p atients with HF over 60 years old were continuously detected.The indexes of echocardiogram,cardiopulmonary exercise test and cardiac catheterization between normal thyroid function patients(normal group)and subclinical hypothyroidism patients(hypothyroidism group)were compared.The incidence rate of cardiac event and all-cause mortality were followed up and compared between the two groups.Results There was no significant difference in echocardiogram paramters between the two groups.The hypothyroidism group showed lower respiratory oxygen consumption[peer oxygen consumption 14.0 VS.15.9 mL/(min·kg);P=0.012]and higher mean pulmonary artery pressure compared to the normal group.In the Kaplan-Meier curves(mean 1098 days),the incidence of cardiac events and all-cause mortality in the hypothyroidism group were significantly higher than those in the normal group(P<0.01).In the Cox proportional hazard analysis,subclinical hypothyroidism was a risk predictor of cardiac events and all-cause mortality in the patients with HF(P<0.05).Conclusions Subclinical hypothyroidism may be associated with poor prognosis in elderly patients with HF,with impaired exercise capacity and elevated pulmonary arterial pressure.

关 键 词：亚临床甲状腺功能减退 心力衰竭 预后 运动能力 

分 类 号：R541.6[医药卫生—心血管疾病]