不同临床特点CHF患者甲状腺激素水平及其与心功能指标的相关性研究  

Thyroid hormone levels among CHF patients with different clinical characteristics and their correlation with heart function indexes

作　　者：沈欢欢 刘蕾 许左隽 孙婷 SHEN Huan-huan;LIU Lei;XU Zuo-jun;SUN Ting(Department of General Practice,Jiangwan Town Community Health Service Center of Hongkou District of Shanghai City,Shanghai,200434,China)

机构地区：[1]上海市虹口区江湾镇街道社区卫生服务中心全科,上海200434 [2]上海交通大学医学院附属第九人民医院心内科

出　　处：《心血管康复医学杂志》2024年第2期131-136,共6页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：2020年上海市“医苑新星”青年医学人才培育资助计划。

摘　　要：目的:研究不同临床特点慢性心力衰竭(CHF)患者甲状腺激素水平及其影响因素,以及与心功能指标的相关性。方法:收集2015年9月至2017年9月我院心内科住院的CHF患者295例,根据不同临床特点进行分组,对比分析各组甲状腺激素水平,以及与心功能指标的相关性,分析CHF合并低总三碘甲状腺原氨酸(TT3)的影响因素。结果:与NYHAⅡ-Ⅲ级组比较,Ⅳ级组FT3[(2.68±0.36)mmol/L比(2.47±0.41)mmol/L]、TT3[(0.84±0.24)mmol/L比(0.68±0.21)mmol/L]水平显著降低;与病程≤2年组比较,病程>2年组TT3[(0.80±0.25)mmol/L比(0.73±0.24)mmol/L]、TT4[(8.77±1.84)mmol/L比(8.37±1.52)mmol/L]水平显著降低;与GFR≥60ml/min组比较,GFR<60ml/min组FT3[(2.67±0.38)mmol/L比(2.47±0.40)mmol/L]、TT3[(0.83±0.23)mmol/L比(0.69±0.24)mmol/L]水平显著降低,P<0.05或<0.01。低TT3组舒张末室间隔厚度(IVSTd)增厚比例显著高于正常TT3组(55.4%比43.0%),P=0.044。Pearson相关分析显示,TT4与LVEF,FT4与LAD呈显著正相关(r=0.126,0.145,P=0.030,0.013),TT3与LVPWT呈显著负相关(r=-0.119,P=0.041)。多因素Logistic回归分析显示,年龄、NYHA分级和IVSTd均是心力衰竭合并低TT3的独立危险因素,P<0.05或<0.01。结论:慢性心力衰竭患者心衰病程延长、心衰加重、伴随肾功能恶化等更容易出现甲状腺激素水平的降低。Objective:To study thyroid hormone levels among patients with chronic heart failure(CHF)and different clinical characteristics and its influencing factors,as well as their correlation with heart function indexes.Methods:A total of 295 CHF patients hospitalized in our Department of Cardiology from Sep 2015 to Sep 2017 were collected,grouped according to different clinical characteristics.Thyroid hormone levels were compared among all groups.Their correlation with cardiac function indexes,influencing factors of CHF complicated low TT3 were analyzed.Results:Compared with NYHA class Ⅱ-Ⅲ group,there were significant reductions in levels of FT3[(2.68±0.36)mmol/L vs.(2.47±0.41)mmol/L]and TT3[(0.84±0.24)mmol/L vs.(0.68±0.21)mmol/L]in classⅣgroup;compared with course≤2 years group,there were significant reductions in levels of TT3[(0.80±0.25)mmol/L vs.(0.73±0.24)mmol/L]and TT4[(8.77±1.84)mmol/L vs.(8.37±1.52)mmol/L]in course>2 years group;compared with GFR≥60ml/min group,there were significant reductions in levels of FT3[(2.67±0.38)mmol/L vs.(2.47±0.40)mmol/L]and TT3[(0.83±0.23)mmol/L vs.(0.69±0.24)mmol/L]in GFR<60ml/min group,P<0.05 or<0.01.Percentage of increased end-diastolic interventricular septal thickness(IVSTd)in low TT3 group was significantly higher than that of normal TT3 group(55.4%vs.43.0%),P=0.044.Pearson correlation analysis indicated that TT4,FT4 was significant positively correlated with LVEF and LAD respectively(r=0.126,0.145,P=0.030,0.013),and TT3 was significant inversely correlated with LVPWT(r=-0.119,P=0.041).Multifactor Logistic regression analysis indicated that age,NYHA class and IVSTd were independent risk factors for CHF complicated low TT3,P<0.05 or<0.01.Conclusion:Patients with chronic heart failure,when accompanied with prolonged disease course,aggravated heart failure,and worsening of kidney function etc.,are more likely to occur reductions of thyroid hormone levels.

关 键 词：心力衰竭 甲状腺激素类 三碘甲状腺原氨酸 心室功能 左 

分 类 号：R541.609[医药卫生—心血管疾病]