亚临床甲状腺功能亢进患者发生心力衰竭的风险概率分布  

Risk Probability Distribution for Heart Failure in Subclinical Hyperthy⁃roidism Patients

作　　者：佟海锋 杨明远 韦伟 王艳梅 唐海玲 TONG Haifeng;YANG Mingyuan;WEI Wei;WANG Yanmei;TANG Hailing(Department of Cardiology,Jingdong Medical District,Chinese PLA General Hospital,Beijing 101149,China;Depart-ment of Internal Medicine,Langfang Changzheng Hospital,Langfang,Hebei 065099,China)

机构地区：[1]解放军总医院京东医疗区心内科,北京101149 [2]廊坊长征医院西医内科,河北廊坊065099

出　　处：《临床误诊误治》2024年第16期24-30,共7页Clinical Misdiagnosis & Mistherapy

基　　金：廊坊市科学技术局2022年廊坊市科学技术研究与发展计划项目(第一批)(2022013048)。

摘　　要：目的分析亚临床甲状腺功能亢进(简称亚临床甲亢)患者发生心力衰竭的风险概率分布情况,以期降低亚临床甲亢患者心力衰竭发生风险并辅助临床干预。方法选择2021年5月至2024年1月收治的133例亚临床甲亢患者作为研究对象,并根据心力衰竭判断标准分为发生组(n=49)和未发生组(n=84)。比较2组一般资料及实验室指标,采用多因素Logistic回归分析筛选心力衰竭发生的影响因素,采用潜在类别分析(LCA)模型比较亚临床甲亢患者心力衰竭发生高风险组与低风险组间影响因素分布特征的差异。结果与未发生组比较,发生组使用血管紧张素转化酶抑制剂/血管紧张素受体阻滞剂药物比例及合并基础疾病比例显著升高,亚临床甲亢病程显著延长(P<0.05)。与未发生组比较,发生组总胆固醇、低密度脂蛋白胆固醇、肿瘤坏死因子(TNF)和B型利钠肽(BNP)水平显著升高,而经皮血氧饱和度、高密度脂蛋白胆固醇(HDL-C)和胰岛素样生长因子-Ⅱ水平显著降低(P<0.01)。亚临床甲亢病程、合并基础疾病、HDL-C、TNF和BNP是亚临床甲亢患者发生心力衰竭的独立影响因素(P<0.05,P<0.01)。与亚临床甲亢并发心力衰竭低风险组比较,高风险组中“高危型分布”占比较高,而“低危型分布”占比较低(P<0.05)。结论亚临床甲亢并发心力衰竭高风险组发生心力衰竭的概率显著高于低风险组,并发心力衰竭高、低风险组中影响因素的分布特征均有差异。Objective To analyze the risk probability distribution of heart failure in patients with subclinical hyperthy-roidism(SH),in order to reduce the risk of patients with SH complicated with heart failure and assist clinical intervention.Methods A total of 133 patients with SH admitted from May 2021 to January 2024 were selected as the research subjects,and the patients were divided into the occurrence group(n=49)and the non-occurrence group(n=84)according to the criteria for judging heart failure.The general data and laboratory indicators of the two groups were compared,and the influencing factors of heart failure were screened by multivariate Logistic regression analysis.The differences in the distribution characteristics of influ-encing factors between the high-risk group and the low-risk group of heart failure in patients with SH were compared by latent class analysis(LCA)model.Results Compared with the non-occurrence group,the proportion of angiotensin converting en-zyme inhibitors/angiotensin receptor blockers and the proportion of underlying diseases in the occurrence group were significantly increased,and the course of SH was significantly prolonged(P<0.05).Compared with the non-occurrence group,the levels of total cholesterol,low-density lipoprotein cholesterol,tumor necrosis factor(TNF)and B-type natriuretic peptide(BNP)in the occurrence group were significantly increased,while the levels of transcutaneous oxygen saturation,high-density lipoprotein cho-lesterol(HDL-C)and insulin-like growth factor-Ⅱwere significantly decreased(P<0.01).The course of SH,combined under-lying disease,HDL-C,TNF and BNP were the independent influencing factors of heart failure in SH patients(P<0.05,P<0.01).Compared with the low-risk group of SH complicated with heart failure,the"high-risk distribution"in the high-risk group was higher,while the"low-risk distribution"was lower(P<0.05).Conclusion The probability of developing heart fail-ure in the high-risk group of subclinical SH complicated with heart failure was significantly

关 键 词：亚临床甲状腺功能亢进 心力衰竭 潜在类别分析 影响因素 高密度脂蛋白胆固醇 B型利钠肽 肿瘤坏死因子 

分 类 号：R581.1[医药卫生—内分泌]