甲状腺功能异常对老年非射血分数下降心力衰竭患者的心血管事件影响  

Effect of thyroid dysfunction on cardiovascular events in eldrly heart failure patients with non-reduced ejection fraction

作　　者：王建龙 刘艳红[1] 彭文近[1] 皮淑芳[1] 王辉[1] 王丹[1] 李田乐 刘迎午[1] Wang Jianlong;Liu Yanhong;Peng Wenjin;Pi Shufang;Wang Hui;Wang Dan;Li Tianle;Liu Yingwu(Department of Cardiology,The Third Central Hospital of Tianjin,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院心脏中心,300170

出　　处：《中华老年心脑血管病杂志》2020年第10期1024-1028,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：天津市科技计划项目(16ZXMJSY00200)。

摘　　要：目的探讨甲状腺功能异常对老年非射血分数下降心力衰竭(HFREF)患者的心血管事件影响。方法连续入选老年非HFREF患者579例,根据游离甲状腺功能三项水平分为甲状腺功能正常组(C1组)338例、亚临床甲状腺功能减退组(C2组)107例、亚临床甲状腺功能亢进组(C3组)31例及低三碘甲状腺原氨酸(T3)综合征组(C4组)103例,随访1年,记录主要终点事件,包括心源性死亡和因心力衰竭发作再住院(再住院)。结果4组因再住院率及病死率比较,差异有统计学意义(P<0.01)。Cox多因素分析显示,促甲状腺素(TSH)>10mIU/L是心源性死亡(95%CI:1.555~14.401,P=0.006)和再住院(95%CI:1.394~4.851,P=0.003)的独立危险因素,单因素分析显示,C2组是心源性死亡和再住院的独立危险因素(95%CI:1.778~8.547,P=0.001;95%CI:1.333~2.901,P=0.001)。Kaplan-Meier生存曲线分析显示,以随访1年再住院为终点事件,C1组生存率明显高于C2组(Plog-rank=0.001),以心源性死亡为终点事件,C1组生存率明显高于C2组和C4组(Plog-rank<0.01)。结论高水平的TSH对老年非HFREF患者更有利于判断长期预后价值。Objective To study the effect of thyroid dysfunction on cardiovascular events in eldrly heart failure(HF)patients with non-reduced ejection fraction.Methods Five hundred and seventy-nine elderly HF patients with non-reduced ejection fraction were divided into C1group(n=338),C2group(n=107),C3group(n=31)and C4group(n=103).The patients were followed up for 1year,during which the cardiogenic death and rehospitalization due to onset of HF were recorded.Results A significant difference was detected between the rehospitalization rate due to onset of HF and mortality in 4groups(P<0.01).Multivariate regression analysis showed that TSH>10mIU/L was an independent risk factor for cardiogenic death and rehospitalization(95%CI:1.555-14.401,P=0.006;95%CI:1.394-4.851,P=0.003).Univariate regression analysis showed that subclinical hypothyroidism was an independent risk factor for cardiogenic death and rehospitalization(95%CI:1.778-8.547,P=0.001;95%CI:1.333-2.901,P=0.001).Kaplan-Meier survival curve analysis showed that rehospitalization due to onset of HF during the 1-year follow-up period was the endpoint event,the survival rate was significantly higher in C1group than in C2group(Plog-rank=0.001)and in C1group than in C2and C4groups when cardiogenic death was considered as the endpoint event(Plog-rank<0.01).Conclusion High serum TSH level is apredictor of the long-term outcome in elderly HF patients with non-reduced ejection fraction.

关 键 词：甲状腺功能亢进症 甲状腺功能减退症 每搏输出量 心力衰竭 三碘甲状腺原氨酸 

分 类 号：R541.6[医药卫生—心血管疾病] R581.2[医药卫生—内科学]