冠心病合并甲状腺功能亢进患者肾素—血管紧张素系统活性及其与并发心房颤动的相关性  

Relationship between renin angiotensin system activity and atrial fibrillation in patients with coronary heart disease and hyperthyroidism

作　　者：孙兑荣 孙宇飞 李君 张宏伟[2] Sun Duirong;Sun Yufei;Li Jun;Zhang Hongwei(Department of Cardiology,Shanxi Cardiovascular Hospital,Shanxi Province,Taiyuan 030001,China)

机构地区：[1]山西省心血管病医院心内科,太原030001 [2]山西省肿瘤医院血液内科,太原030013

出　　处：《疑难病杂志》2023年第4期356-360,共5页Chinese Journal of Difficult and Complicated Cases

基　　金：山西省自然科学基金(201701D121165)。

摘　　要：目的分析冠心病合并甲状腺功能亢进(甲亢)患者肾素—血管紧张素系统活性及其与并发心房颤动(房颤)的相关性。方法选取2020年4月—2022年7月山西省心血管病医院收治的冠心病患者75例为冠心病组,冠心病合并甲亢患者75例为合并甲亢组,同期健康体检者75例为健康对照组,比较各组受试者肾素—血管紧张素系统活性[血浆肾素(PRA)、血管紧张素转换酶(ACE)、血管紧张素Ⅱ(ATⅡ)]、左心房内径(LAD),应用Pearson分析肾素—血管紧张素系统活性与促甲状腺激素(TSH)、血清游离三碘甲状腺原氨酸(FT_(3))、血清游离甲状腺素(FT_(4))、LAD的相关性,采用多因素Logistic回归分析冠心病合并甲亢患者并发房颤的相关影响因素。结果PRA、ACE、ATⅡ、LAD水平比较,合并甲亢组>冠心病组>健康对照组(P<0.05);PRA、ACE、ATⅡ、LAD水平比较,冠心病组、合并甲亢组有房颤患者均高于无房颤患者(P<0.05),合并甲亢组有房颤患者均高于冠心病组有房颤患者(P<0.05),合并甲亢组无房颤患者均高于冠心病组无房颤患者(P<0.05),持续性房颤患者均高于阵发性房颤患者(t/P=9.647/<0.001、2.584/0.012、13.133/<0.001、3.559/<0.001)。血清TSH水平比较,合并甲亢组<冠心病组<健康对照组(F/P=349.626/<0.001),血清FT_(3)、FT_(4)水平比较,合并甲亢组>冠心病组>健康对照组(F/P=472.196/<0.001、506.342/<0.001)。Pearson相关性分析显示,PRA与TSH呈正相关,ATⅡ、ACE与TSH呈负相关(r=0.769、-0.792、-0.803,P<0.001);ACE与FT_(3)、FT_(4)呈正相关(r=0.718、0.680,P<0.001);PRA、ACE、ATⅡ与LAD呈正相关(r=0.795、0.790、0.751,P均<0.001);Logistic回归分析显示,TSH低、FT_(3)高、FT_(4)高、PRA高、ACE高、ATⅡ高是冠心病合并甲亢患者并发房颤的危险因素[OR(95%CI)=9.080(1.694~48.671)、10.103(1.582~64.519)、10.200(1.805~57.643)、12.730(1.947~83.226)、15.123(3.684~62.081)、9.667(1.032~90.557)]。结论冠心病合并甲亢患者PRAObjective To analyze the activity of renin angiotensin system and its correlation with atrial fibrillation(AF)in patients with coronary heart disease and hyperthyroidism.Methods From April 2020 to July 2022,75 patients with coronary heart disease admitted to the Shanxi Provincial Cardiovascular Hospital were selected as the coronary heart disease group,75 patients with coronary heart disease combined with hyperthyroidism as the hyperthyroidism group,and 75 healthy subjects in the same period were selected as the healthy control group.The renin angiotensin system activity[plasma renin(PRA),angiotensin converting enzyme(ACE),angiotensin II(AT II),and left atrial diameter(LAD)]of the subjects in each group were compared,Pearson was used to analyze the correlation between the activity of the renin angiotensin system and thyroid stimulating hormone(TSH),serum free triiodothyronine(FT_(3)),serum free thyroxine(FT_(4)),and LAD.Multivariate logistic regression was used to analyze the related influencing factors of atrial fibrillation in patients with coronary heart disease and hyperthyroidism.Results The levels of PRA,ACE,ATⅡ,and LAD in patients with hyperthyroidism were higher than those in patients with coronary heart disease and healthy controls(P<0.05);The levels of PRA,ACE,ATⅡ,and LAD in patients with atrial fibrillation in the coronary heart disease group and hyperthyroidism group were higher than those without atrial fibrillation(P<0.05).The levels of patients with atrial fibrillation in the hyperthyroidism group were higher than those in the coronary heart disease group(P<0.05).The levels of patients without atrial fibrillation in the hyperthyroidism group were higher than those without atrial fibrillation in the coronary heart disease group(P<0.05),Patients with persistent atrial fibrillation were higher than those with paroxysmal atrial fibrillation(t/P=9.647/<0.001,2.584/0.012,13.133/<0.001,3.559/<0.001).Comparison of serum TSH levels in patients with hyperthyroidism<coronary heart disease<healthy control

关 键 词：冠心病 甲状腺功能亢进 心房颤动 肾素—血管紧张素系统 

分 类 号：R541.4[医药卫生—心血管疾病] R581.1[医药卫生—内科学]