血清甲状腺激素水平与心力衰竭患者住院期间预后的相关性研究  

Relationship between Serum Thyroid Hormone Levels and Prognosis during Hospitalization in Heart Failure Patients

作　　者：彰金[1] 丁治国[2] 祁烁[2,3] 李颖[4] 李伟强[4] 张媛媛 周通[4] ZHANG Jin;DING Zhiguo;QI Shuo;LI Ying;LI Weiqiang;ZHANG Yuanyuan;ZHOU Tong(Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China;Thyropathy Hospital,SUN Si Miao Hospital of Beijing University of Chinese Medicine,Tongchuan 727100,China;Department of Thyroid,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China;Department of Nuclear Medicine,Dongzhimen Hospital of Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京市100700 [2]北京中医药大学孙思邈医院甲状腺病院,陕西省铜川市727100 [3]北京中医药大学东直门医院甲状腺病科,北京市100700 [4]北京中医药大学东直门医院核医学科,北京市100700

出　　处：《中国全科医学》2023年第33期4125-4129,共5页Chinese General Practice

基　　金：陕西省重点研发计划项目(2023-ZDLSF-56);吴阶平医学基金会项目(320.6750.2022-03-9);陕西省中医药管理局项目(SZY-NLTL-2022-005,SZY-NLTL-2022-006)。

摘　　要：背景笔者在临床工作中发现住院期间死亡的心力衰竭患者血清反三碘甲状腺原氨酸(rT_(3))检测值多明显高于生物参考区间上限。既往关于甲状腺激素对心力衰竭患者住院期间死亡预测的研究,特别是rT_(3)预测价值的研究较少。探索对心力衰竭患者住院期间死亡有预测价值的指标具有重要临床指导意义。目的探讨血清甲状腺激素与心力衰竭患者住院期间预后的相关性。方法纳入2019年4月—2022年4月于北京中医药大学东直门医院住院治疗的197例心力衰竭患者为研究对象。通过电子病历系统收集研究对象的基线资料。所有研究对象入院24 h内采集空腹静脉血检测总三碘甲状腺原氨酸(TT_(3))、总甲状腺素(TT_(4))、游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、促甲状腺激素(TSH)、rT_(3)和N-末端脑钠肽前体(NT-pro-BNP)。根据研究对象住院期间是否死亡分为死亡组(n=18)和非死亡组(n=179)。采用多因素Logistic回归分析探讨心力衰竭患者住院期间死亡的影响因素。绘制受试者工作特征曲线(ROC曲线)评价相关指标对心力衰竭患者住院期间死亡的预测价值,计算ROC曲线下面积(AUC),并采用Delong检验比较各指标的AUC。结果死亡组年龄、rT_(3)高于非死亡组,FT_(3)、TT_(3)、TSH低于非死亡组(P<0.05)。非死亡组患者中66例甲状腺功能正常,87例低T_(3)综合征,15例单独FT_(4)高,3例单独TT_(4)高,5例TT_(4)、FT_(4)均高,1例单独TT_(4)低,1例单独TT_(3)高,1例单独FT_(3)高;死亡组患者中1例甲状腺功能正常,14例低T_(3)综合征,3例单独FT_(4)高。两组患者低T_(3)综合征发病率比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,rT_(3)是心力衰竭患者住院期间死亡的影响因素[OR=5.245,95%CI(2.283,12.050),P<0.05]。ROC曲线结果显示rT_(3)预测心力衰竭患者住院期间死亡的AUC为0.914[95%CI(0.865,0.962)],大于年龄(Z=3.137Background The serum reverse triiodothyronine(rT_(3))values of heart failure patients who died during hospitalization were found significantly higher than the upper limit of the biological reference interval in the clinical work of the author.The prediction of thyroid hormones,especially rT_(3),on death during hospitalization of heart failure patients was rare reported in the previous studies,it is of great clinical significance to explore the indicators with predictive value for death during hospitalization in patients with heart failure.Objective To investigate the relationship between serum thyroid hormones and prognosis during hospitalization in patients with heart failure.Methods A total of 197 patients with heart failure admitted to Dongzhimen Hospital of Beijing University of Chinese Medicine from April 2019 to April 2022 were included in the study.Baseline data of the study subjects were collected by the electronic medical record system.Fasting venous blood of all subjects was collected within 24 h after admission for total triiodothyronine(TT_(3)),total thyroxine(TT_(4)),free triiodothyronine(FT_(3)),free thyroxine(FT_(4)),thyroid stimulating hormone(TSH),rT_(3)and N-terminal brain natriuretic peptide precursor(NT-pro-BNP).Subjects were divided into death group(n=18)and non-death group(n=179)according to the occurrence of death during hospitalization.Multivariate Logistic regression analysis was used to investigate the influencing factors of death during hospitalization in patients with heart failure.Receiver operating curve(ROC curve)was plotted to evaluate the predictive value of related indicators on death during hospitalization in patients with heart failure,and the area under curve(AUC)of each indicator was calculated and compared by Delong test.Results The age and rT_(3)of death group were higher than those of non-death group,while FT_(3),TT_(3)and TSH of death group were lower than those of non-death group,with statistically significant differences(P<0.05).In the non-death group,66 patients had no

关 键 词：心力衰竭 低T3综合征 反三碘甲状腺原氨酸 甲状腺激素 预后 影响因素分析 

分 类 号：R87[医药卫生—运动医学]