亚临床甲减增加女性患者冠状动脉旁路移植术后呼吸道感染风险  

Subclinical hypothyroidism increases the risk of respiratory tract infection in female patients after coronary artery bypass grafting

作　　者：郑辉[1,2] 樊国亮[3] 常宝成[1] 葛焕琦[2] 张春风[2] 郭夏[2] Zheng Hui;Fan Guoliang;Chang Baocheng;Ge Huanqi;Zhang Chunfeng;Guo Xia(NHC Key Laboratory of Hormones and Development(Tianjin Medical University),Tianjin Key Laboratory of Metabolic Diseases,Tianjin Medical University Metabolic Diseases Hospital&Tianjin Institute of Endocrinology,Tianjin 300070,China;TEDA International Cardiovascular Disease Hospital,Endocrine Department,Tianjin 300457,China;TEDA International Cardiovascular Disease Hospital,Intensive Care Unit,Tianjin 300457,China)

机构地区：[1]国家卫生健康委员会激素与发育重点实验室天津市代谢性疾病重点实验室天津医科大学朱宪彝纪念医院天津市内分泌研究所,300134 [2]泰达国际心血管病医院内分泌科,天津300457 [3]泰达国际心血管病医院ICU,天津300457

出　　处：《中华胸心血管外科杂志》2020年第5期284-290,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：重点基础研究发展计划(2018YFC314000);滨海新区卫计委重点支持项目(2014BWKZ007)。

摘　　要：目的探讨亚临床甲状腺功能减退症(SCH)对冠状动脉旁路移植术(CABG)患者术后并发症的影响。方法回顾性分析2016年1月至2017年12月期间920例单纯行CABG患者的临床资料。根据血清促甲状腺素(TSH)水平,将患者分为甲状腺功能正常组(NC组,814例,0.27 mIU/L≤TSH≤4.2 mIU/L)和亚临床甲状腺功能减退组(SCH组,106例,TSH>4.2 mIU/L)。两组内再按照性别分亚组。比较各组患者术前临床资料、手术情况、围手术期并发症和1年旁路移植血管狭窄率。结果与NC组比较,SCH组女性患者多(53.8%对24.4%,P=0.000),吸烟比例低(38.7%对58.0%,P=0.000),其他临床基线资料和术后并发症差异均无统计学意义(P>0.05)。按照性别亚组分析发现,合并SCH的女性患者术后呼吸道感染发生比例升高(10.5%对3.5%,P=0.034),而男性患者间差异无统计学意义(P>0.05)。TSH是女性CABG患者术后呼吸道感染的独立危险因素(OR=1.307,95%CI=1.110~1.539,P=0.001)。亚组分析结果显示,与男性相比,SCH组女性高血压(84.2%对67.3%,P=0.041)、糖尿病(45.6%对16.3%,P=0.001)患病率增加,ICU住院时间(44 h对42 h,P=0.003)、急性肾衰竭(10.5%对0,P=0.019)及大输血发生比例(8.8%对0,P=0.034)均显著增加。结论SCH可能通过增加CABG术后呼吸道感染发生影响女性患者预后。Objective To explore the effect of subclinical hypothyroidism(SCH)on complications after coronary artery bypass grafting(CABG).Methods The data of CABG patients hospitalized in TEDA International Cardiovascular Disease Hospital from January 2016 to December 2017 were retrospectively analyzed.According to the thyroid function after admission,the patients were divided into normal thyroid function group(NC group,814 cases,0.27 mIU/L≤TSH≤4.2 mIU/L)and subclinical hypothyroidism group(SCH group,106 cases,TSH>4.2 mIU/L).The preoperative clinical data,surgical conditions,recent complications and one-year bridge stenosis rate were compared between the two groups in male or female.Results Compared with NC group,SCH group had more female patients(53.8%vs 24.4%,P=0.000),lower smoking rate(38.7%vs 58.0%,P=0.000).There was no statistical difference in other baseline data and postoperative complications(P>0.05).Subgroup analysis depending on gender showed that the incidence of respiratory tract infection increased in female patients with SCH(10.5%vs 3.5%,P=0.034)compared with those in NC group,there was no significant difference in male.The TSH level was an independent risk factor for respiratory tract infection in female patients(OR=1.307,95%CI=1.110-1.539,P=0.001).Compared with the male patients,the prevalence of hypertension(84.2%vs.67.3%,P=0.041),diabetes mellitus(45.6%vs 16.3%,P=0.001),hospitalization time in ICU(44 h vs.42 h,P=0.003),acute renal failure(10.5%vs 0,P=0.019)and massive blood transfusion(8.8%vs 0,P=0.034)increased.Conclusion SCH appears to influence the postoperative outcome for female patients by increasing the development of postoperative respiratory tract infection.

关 键 词：亚临床甲状腺功能减退症 冠状动脉旁路移植术 女性 术后呼吸道感染 

分 类 号：R65[医药卫生—外科学]