甲状腺功能与心脏瓣膜术后新发房颤风险的关联性分析  

Analysis of the correlation between preoperative free thyroxine levels and the risk of new-onset atrial fibrillation after cardiac valve surgery

作　　者：张晓东 牛晶晶 赵宏磊 Zhang Xiaodong;Niu Jingjing;Zhao Honglei(Department of Cardiac Vascular Surgery,Linyi Central Hospital,Linyi 276401,China;Department of Cardiology,Linyi Central Hospital,Linyi 276401,China;Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]临沂市中心医院心脏大血管外科,临沂276401 [2]临沂市中心医院心脏内科,临沂276401 [3]首都医科大学附属北京安贞医院心脏外科,北京100029

出　　处：《中华胸心血管外科杂志》2024年第8期473-479,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨患者术前游离甲状腺素(free thyroxine, FT4)水平与心脏瓣膜术后新发房颤(atrial fibrillation, AF)风险的相关性, 及时识别心脏瓣膜术后新发AF的高危患者。方法回顾性纳入2019年12月至2023年1月在北京安贞医院心外科进行心脏瓣膜置换或成形手术的瓣膜心脏病患者(≥18岁)。排除甲状腺功能检测超过正常参考范围(7.64~16.03 pmol/L)的患者, 最终入组2 645例, 其中男1 597例, 女1 048例;年龄18~83岁, 中位年龄56(46, 64)岁。合并高血压1 891例(71.5%), 合并2型糖尿病176例(6.7%)。根据FT4水平的四分位数将患者分为4组, 其中1组661例, FT4水平7.64~10.33 pmol/L;2组661例, FT4水平10.33~11.36 pmol/L;3组661例, FT4水平11.36~12.54 pmol/L;4组662例, FT4水平12.54~13.66 pmol/L。比较4组患者发生术后AF的风险, 采用logistics回归校正相关危险因素, 分析不同组别发生术后AF的比值比(odds ratio, OR)和95%置信区间(confidence interval, CI)。根据年龄、性别、有无高血压、BNP水平分亚组, 比较不同亚组内FT4水平与新发AF的关联性。结果 4组患者的年龄、体质量指数、高血压、高脂血症、脑钠肽、肾小球滤过率、甘油三酯、总胆固醇水平差异有统计学意义(P<0.05), 其他指标差异无统计学意义(P>0.05)。以FT4水平最低组为基线, FT4较高组发生术后新发AF的风险较高, 且随着FT4水平升高, 术后新发AF呈显著递进式升高趋势。根据年龄、性别、有无高血压、脑钠肽水平分层, 不同亚组内仍呈现相似的趋势。约登指数最大值0.193, FT4临界值11.485 pmol/L。结论在甲状腺功能正常的瓣膜心脏病患者中, 术前较高的FT4水平与心脏瓣膜术后新发AF的风险具有显著相关性。当患者术前FT4水平>11.485 pmol/L时, 即使甲状腺功能仍处于正常范围内, 仍应密切监测患者术后新发AF的风险。ObjectiveTo evaluate the relationship between preoperative free thyroxine(FT4)levels and the risk of newonset atrial fibrllation(AF)after cardiac valve surgery in patients with normal thyroid function,and to identify high-risk individuals for postoperative AF among patients undergoing cardiac valve surgery.Methods This retrospective study enrolled patients(≥18 years old)with valvular heart disease who underwent heart valve replacement or valvoplasty surgery from December 2019 to January 2023 in Beijing Anzhen Hospital.Patients with thyroid function tests exceeding the normal reference range(7.64-16.03 pmol/L)were excluded,resulting in a final cohort of 2645 patients,including 1597 males and 1048 females;aged 18-83 years,with a median age of 56(46,64)years.Among them,1891 patients(71.5%)had hypertension,and 176(6.7%)had type 2 diabetes.The patients were divided into four groups based on quartiles of FT4 levels:Group 1(n=661)with FT4 levels of 7.64-10.33 pmol/L,Group 2(n=661)with 10.33-11.36pmol/L,Group 3(n=661)with 11.36-12.54 pmol/L,and Group 4(n=662)with 12.54-13.66pmol/L.The risk of postoperative AF was compared among the four groups,and logistic regression was used to adjust for relevant risk factors.The odds ratio(OR)and 95%confidence interval(CI)for postoperative AF across different groups were analyzed.Subgroup analyses were performed based on age,gender,hypertension status,and B-type natriuretic peptide(BNP)levels to compare the association between FT4 levels and new-onset AF within different subgroups.Results Statistically significant differences were observed among the four groups in terms of age,body mass index,hypertension,hyperlipidemia,BNP,glomerular filtration rate,triglyceride,and total cholesterol levels(P<0.05),while no significant differences were found in other indicators(P<0.05).Using the lowest FT4 group as the baseline,a higher risk of postoperative new-onset AF was observed in groups with higher FT4 levels,with a significant trend of incremental increase in postoperative AF with rising FT

关 键 词：甲状腺功能 心脏瓣膜术 心房颤动 游离甲状腺素 

分 类 号：R654.2[医药卫生—外科学] R541.75[医药卫生—临床医学]