外周血炎性指标与甲状腺激素水平对急性心肌梗死患者合并心力衰竭的诊断价值  

Diagnostic value of inflammatory indices in peripheral blood and thyroid hormone level on patients with acute myocardial infarction complicated with heart failure

作　　者：陈宗洋 钱福东[3] 储岳峰[3] 朱杰[3] CHEN Zong-yang;QIAN Fu-dong;CHU Yue-feng;ZHU Jie(Bengbu Medical College,Bengbu 233000,Anhui,China;Department of Cardiology,Lu An Fourth People's Hospital,Lu'an 237000,Anhui,China;Department of Cardiology,Lu'an People's Hospital,Lu'an 237000,Anhui,China)

机构地区：[1]蚌埠医学院,安徽省蚌埠市233000 [2]六安市第四人民医院心内科,安徽省六安市237000 [3]六安市人民医院心内科,安徽省六安市237000

出　　处：《广西医学》2022年第17期1955-1960,共6页Guangxi Medical Journal

基　　金：安徽医科大学校科研基金立项资助项目(2020xkj228)。

摘　　要：目的探讨外周血炎性指标与甲状腺激素水平对急性心肌梗死(AMI)患者合并心力衰竭的诊断价值。方法回顾性分析178例AMI患者的临床资料,将Killip分级为Ⅰ级的患者纳入非心力衰竭组(n=91),将Killip分级为Ⅱ~Ⅳ级的患者纳入心力衰竭组(n=87)。收集两组患者的临床资料及实验室指标。采用多因素Logistic回归模型分析AMI患者合并心力衰竭的影响因素。采用受试者工作特征(ROC)曲线分析外周血炎性指标与甲状腺激素水平对AMI患者合并心力衰竭的诊断价值。结果心力衰竭组患者的左心室射血分数(LVEF)低于非心力衰竭组,心房颤动发生率高于非心力衰竭组(均P<0.05)。心力衰竭组患者的游离三碘甲腺原氨酸(FT_(3))、总三碘甲腺原氨酸(TT_(3))及总甲状腺素水平均低于非心力衰竭组,白细胞计数、中性粒细胞计数、血小板计数,以及超敏C反应蛋白(hs-CRP)、肌钙蛋白T峰值、N-末端脑钠肽前体水平,以及血小板与淋巴细胞比值和中性粒细胞与淋巴细胞比值均高于非心力衰竭组(均P<0.05)。多因素Logistic回归分析结果显示,hs-CRP水平升高是AMI患者合并心力衰竭的独立危险因素,LVEF及FT_(3)、TT_(3)水平升高是AMI患者合并心力衰竭的保护因素(均P<0.05)。ROC曲线结果显示,LVEF、hs-CRP、FT_(3)及TT_(3)水平联合诊断AMI患者合并心力衰竭的ROC曲线下面积为0.943(P<0.05)。结论hs-CRP升高是AMI患者合并心力衰竭的独立危险因素,LVEF及FT_(3)、TT_(3)水平升高是AMI患者合并心力衰竭的保护因素,四者联合检测对AMI患者合并心力衰竭有较好的诊断效能。Objective To explore the diagnostic value of inflammatory indices in peripheral blood and thyroid hormone level on patients with acute myocardial infarction(AMI)complicated with heart failure.Methods The clinical data of 178 AMI patients were retrospectively analyzed.The patients in Killip gradeⅠwere enrolled in non-heart failure group(n=91),and the patients in Killip gradeⅡ-Ⅳwere enrolled in heart failure group(n=87).The clinical data and laboratory indices of the two groups were collected.The multivariate Logistic regression model was performed to analyze the influencing factors for AMI patients complicated with heart failure.The receiver operating characteristic(ROC)curve was employed to analyze the diagnostic value of inflammatory indices in peripheral blood and thyroid hormone level on AMI patients complicated with heart failure.Results The left ventricular ejection fraction(LVEF)of the heart failure group was lower than that of the non-heart failure group,and the incidence rate of atrial fibrillation was higher in the heart failure group than in the non-heart failure group(all P<0.05).The heart failure group exhibited lower levels of free triiodothyronine(FT_(3)),total triiodothyronine(TT_(3))and total thyroxine,and higher counts of white blood cells,neutrophils,platelets,as well as higher levels of high-sensitivity C-reactive protein(hs-CRP),peak troponin T(TnT),N-terminal pro-brain natriuretic peptide,and higher platelet-to-lymphocyte ratio,neutrophil-to-lymphocyte ratio as compared with the non-heart failure group(all P<0.05).The results of multivariate Logistic regression analysis revealed that the elevation of hs-CRP was the independent risk factor for AMI patients complicated with heart failure,and the elevations of LVEF,FT_(3) and TT_(3) levels were the protective factors for AMI patients complicated with heart failure(all P<0.05).The results of ROC curve interpreted that the area under the ROC curve of the levels of LVEF,hs-CRP,FT_(3) and TT_(3) for collaboratively diagnosing AMI patients comp

关 键 词：急性心肌梗死 心力衰竭 炎症指标 甲状腺激素 诊断效能 

分 类 号：R542.22[医药卫生—心血管疾病]