老年慢性心力衰竭患者出现甲状腺功能减退对预后的影响

目的观察老年慢性心力衰竭患者中不同甲状腺功能状态对临床预后和心功能状态的影响。方法回顾性分析2007年1月至2010年12月共4年期间居住于深圳市龙岗社区65岁以上的老年慢性心力衰竭患者的病历档案和就诊记录,并对有基线甲状腺功能检查的患者进行横断面的电话随访调查,随访指标包括全因死亡、心血管死亡、再住院、心力衰竭急性发作和急性心肌梗死等复合终点。结果共入选曾做过基线甲状腺功能检测的心力衰竭患者277例,其中甲状腺功能减退组[促甲状腺激素(TSH)升高或三碘甲状腺氨酸(T3)降低]83例,占30%。随访时间3.8(3～5)年。甲状腺功能减退组有30例发生复合终点事件,而甲状腺功能正常组有48例发生复合终点事件,两组比较差异有统计学意义[35.7%(30/83)vs.24.8%(48/194),P<0.01]。结论老年慢性心力衰竭患者中合并甲状腺功能减退者的预后较差。

Effect of hypothyroidism on prognosis in elderly patients with chronic heart failure

Objectives To observe the predictive value of hypothyroidism in elderly patients with chronic heart failure （CHF）. Methods Data of 277 patients with CHF aged more than 65 years were enrolled in this retrospective study. They resided in Longgang District, Shenzhen and were diagnosed as CHF from January 2007 to December 2010. Their medical records were reviewed and telephone follow-up were done in this cross-sectional study. The follow-up indices were as follows： death from all causes, death from cardiovascular disease, re-admission, acute episode of HF and acute myocardial infarction. Results Duration of follow-up was 3.8 （3-5） years. There were 83 patients （30%） of all cases had clinical and sub-clinical hypothyroidism （elevated thyroid stimulating hormone or decreased triiodothyronine level）, 30 of which developed to composite adverse events. Compared to those who had normal thyroid function, hypothyroidism patients had worse clinical outcomes [35.7% （30/83） vs. 24.8% （48/194）, P〈0.01]. Conclusions Elderly patients with CHF combined with hypothyroidism may have worse clinical outcomes.