游离T4/游离T3与老年急性冠状动脉综合征患者病情和院内预后的相关性分析  

Correlation Between FT4/FT3 Ratio and Clinical Feature and Prognosis During Hospitalization of Elderly Patients With Acute Coronary Syndrome

作　　者：袁晓鹏 李爽 吕纳强[4] 郭鹏召 张传奇 崔启 王潇 杨进刚[4] 杨跃进[4] 高传玉 张静 党爱民[4] YUAN Xiaopeng;LI Shuang;LYU Naqiang;GUO Pengzhao;ZHANG Chuanqi;CUI Qi;WANG Xiao;YANG Jingang;YANG Yuejin;GAO Chuanyu;ZHANG Jing;DANG Aimin(Coronary Heart Disease Intensive Care Unit,Zhengzhou University People’s Hospital,Henan Provincial People’s Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou(450003),Henan,China)

机构地区：[1]郑州大学人民医院,河南省人民医院,阜外华中心血管病医院,冠心病重症监护室,河南省郑州市450003 [2]郑州大学人民医院,河南省人民医院,阜外华中心血管病医院,特需一病区,河南省郑州市450003 [3]郑州大学人民医院,河南省人民医院,阜外华中心血管病医院,冠心病一病区,河南省郑州市450003 [4]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心内科

出　　处：《中国循环杂志》2021年第5期439-443,共5页Chinese Circulation Journal

基　　金：国家科技支撑计划课题(2011BAI11B02);中国医学科学院医学与健康科技创新工程(2017-I2M-2-002)。

摘　　要：目的:探讨甲状腺激素与老年急性冠状动脉综合征患者病情严重程度和住院期间死亡风险的关系。方法:选取2019年1月1日至2020年8月31日阜外华中心血管病医院冠心病重症监护室(CCU)65岁以上急性冠状动脉综合征患者505例,在人数大致相等的情况下将患者根据游离T4/游离T3(FT4/FT3)四分位进行分组:组1(<4.19,n=126)、组2(4.19~4.99,n=127)、组3(5.00~6.46,n=126)、组4(>6.46,n=126)。比较各组患者的基线资料和院内死亡情况;应用ROC曲线评估FT4/FT3、GRACE评分、FT4/FT3联合GRACE评分对院内死亡的预测能力;采用Kaplan-Meier生存曲线及Cox比例风险回归分析评估FT4/FT3对院内死亡的影响。结果:组4患者入院时血压、心率、C反应蛋白、血肌酐、中性粒细胞计数与淋巴细胞计数比值、糖化血红蛋白、同型半胱氨酸、左心室射血分数、Killip心功能分级≥3级、GRACE评分与其他各组的差异均有统计学意义(P均<0.05)。ROC曲线显示,FT4/FT3、GRACE评分及FT4/FT3联合GRACE评分能预测老年急性冠状动脉综合征患者住院期间的死亡风险,AUC分别为0.734、0.796、0.820(P均<0.05)。Kaplan-Meier生存分析和Cox比例风险回归分析显示,在老年急性冠状动脉综合征患者中,随着FT4/FT3增高,住院期间死亡风险增加(RR=1.25,95%CI:1.07~1.46,P=0.032)。结论:FT4/FT3与老年急性冠状动脉综合征患者病情严重程度和院内预后有关。Objectives:To investigate the relationship between FT4/FT3 ratio and clinical feature and in-hospital outcome in aged patients with acute coronary syndrome.Methods:A total of 505 aged patients(over 65 years old)admitted in the Coronary Heart Disease Intensive Care Unit(CCU)of Fuwai Central China Cardiovascular Hospital with acute coronary syndromes from January 1,2019 to August 31,2020 were enrolled in this study,patients were divided into 4 groups according to FT4/FT3 ratio:group 1(<4.19,n=126),group 2(4.19-4.99,n=127),group 3(5.00-6.46,n=126),group 4(>6.46,n=126).The basic clinical variables were compared between the groups;ROC curve was used to evaluate the predictive ability of FT4/FT3,GRACE scores and FT4/FT3 combined with GRACE scores on in-hospital death;Kaplan-Meier survival analysis and Cox proportional hazard regression were used to evaluate the impact of FT4/FT3 on in-hospital death.Results:The systolic blood pressure,diastolic blood pressure,heart rate,C-reactive protein,creatinine,neutrophilto-lymphocyte ratio,glycated hemoglobin,homocysteine,left ventricular ejection fraction,Killip≥3,GRACE scores were statistically different between group 4 and the other three groups(all P<0.05).ROC curve shows that FT4/FT3,GRACE scores and FT4/FT3 combined GRACE scores can predict the mortality risk of aged patients with acute coronary syndrome during hospitalization.The AUC was 0.734,0.796,0.820,respectively(all P<0.05).Kaplan-Meier survival analysis and Cox proportional hazard assessment showed that the mortality rate during hospitalization increased in proportion to the increase of FT4/FT3 in aged patients with acute coronary syndrome(RR=1.25,95%CI:1.07-1.46,P=0.032).Conclusions:FT4/FT3 ratio is related to the severity and the prognosis in the hospital among aged patients with acute coronary syndrome.

关 键 词：老年 急性冠状动脉综合征 甲状腺激素 院内死亡 

分 类 号：R54[医药卫生—心血管疾病]