低T3综合征对重症心肌炎患者临床不良终点事件的影响

目的:探讨低三碘甲状腺原氨酸(T3)综合征对重症心肌炎患者发生临床不良终点事件的影响。方法:连续入选2013年7月—2019年12月于郑州大学第一附属医院CCU住院的重症心肌炎患者113例,根据入院时的血清游离三碘甲状腺原氨酸(FT3)水平,将患者分为低T3组(FT3<3.1 pmol/L,32例)与正常T3组(3.1 pmol/L≤FT3≤6.8 pmol/L,81例),比较两组患者基线资料、入院心功能状态的差异,观察临床不良终点事件的发生情况。结果:与正常T3组相比较,低T3组入院时收缩压更低,心率更快,更易发生室性心动过速/心室颤动(室速/室颤)和心力衰竭,肌酸激酶同工酶(CK-MB)、肌酐水平更高,左室射血分数(LVEF)显著降低(均P<0.05)。FT3水平越低,NYHA分级越趋向于Ⅳ级,LVEF越低。与正常T3组相比,低T3组发生心源性死亡、复合不良心血管事件和出血事件显著增加(均P<0.05)。正常T3组患者具有明显的生存优势。Logistic回归分析表明低血清FT3水平是临床不良终点事件的独立危险因素(复合不良心血管事件:OR=2.767,P=0.047,95%CI:1.014~7.552;心源性死亡:OR=3.333,P=0.015,95%CI:1.267~8.772;出血事件:OR=3.994,P=0.004,95%CI:1.563~9.952)。结论:低T3综合征会增加重症心肌炎患者发生复合不良心血管事件和出血事件的风险,显著升高死亡风险。

Impact of low T3 syndrome on clinical adverse events in patients with severe myocarditis

Objective:To investigate the impact of low T3 syndrome on adverse clinical endpoints in patients with severe myocarditis.Methods:A total of 113 patients with severe myocarditis admitted to the Critical Care Unit of the First Affiliated Hospital of Zhengzhou University from July 2013 to December 2019 were enrolled and divided into the low T3 group(FT3<3.1 pmol/L,n=32)and the normal T3 group(3.1 pmol/L≤FT3≤6.8 pmol/L,n=81)according to the serum free triiodothyronine(FT3)level.The baseline data and cardiac function were statistically compared between the two groups.The clinical endpoints were observed.Results:Compared with the normal T3 group,the low T3 group had lower systolic blood pressure,faster heart rate,higher incidences of ventricular tachycardia,ventricular fibrillation and heart failure,higher levels of creatine kinase isoenzyme(CK-MB)and creatinine,as well as lower left ventricular ejection fraction(LVEF)(all P<0.05).The lower the level of FT3,the higher NYHA grade and the lower LVEF.Compared with the normal T3 group,the incidence of cardiac death,compisite adverse cardiovascular events and bleeding events increased significantly in the low T3 group(all P<0.05).Patients in the normal T3 group had a significant survival advantage.Logistic regression analysis showed that the low serum FT3 level was an independent risk factor for adverse clinical end-point events(compisite adverse cardiovascular events:OR=2.767,P=0.047,95%CI:1.014-7.552;cardiac death:OR=3.333,P=0.015,95%CI:1.267-8.772;bleeding events:OR=3.994,P=0.004,95%CI:1.563-9.952).Conclusion:Low T3 syndrome can increase the risk of severe myocarditis combined with adverse vascular events and bleeding events,which can significantly increase the mortality.