冠心病患者甲状腺功能及FT3与冠状动脉病变关系的研究

目的：探讨冠心病患者甲状腺功能情况及游离甲状腺素（FT3）水平与冠脉病变的关系。方法：选择2012年至2014年期间入住我院，经冠脉造影证实的238名冠心病患者，分析其甲状腺功能情况；在排除甲亢、亚临床甲亢，甲状腺功能（甲减）、亚临床甲减后，其余217例患者根据FT3水平被分为正常FT3组（192例）和低FT3组（25例），比较两组患者一般临床情况和冠脉造影结果。结果：（1）238名患者中甲亢2例（0.84％），甲减11例（4.62％），亚临床甲亢3例（1.26％），亚临床甲减5例（2.10％），低T3综合征25例（10.50％）；（2）与正常FT3组比较，低FT3组患者总胆固醇[TC ，（4.14±1.59） mmol/L比（7.33±1.72） mmol/L]、载脂蛋白 E [ApoE ，（3.91±0.98） mmol/L比（4.55±1.52） mmol/L]、肌酐[Cr ，（97.99±30.85）μmol/L比（116.64±43.20）μmol/L]、N末端B型利钠肽原[NT-proBNP ，140（62-462） pg/ml比739（304-4922） pg/ml]水平显著升高（P均＜0.01）；（3）冠心病患者中FT3降低的患者合并三支病变的比例显著高于正常 FT3组（76.0％比40.1％， P＜0.01）。结论：低游离甲状腺素综合征是冠心病患者最常见的甲状腺功能异常，游离甲状腺素水平降低的患者更容易多支血管受累。

Relationship among thyroid function,FT3 level and coronary artery disease in patients with coronary heart disease

Objective：To explore the relationship among thyroid function ,free thyroxine （FT3） level and coronary artery disease in patients with coronary heart disease （CHD） .Methods ：A total of 238 CHD patients ,who hospital-ized in our hospital from 2012 to 2014 and were proved by coronary angiography （CAG） ,were selected .Their thy-roid function was analyzed .After patients with hyperthyroidism ,hypothyroidism ,subclinical hyperthyroidism and subclinical hypothyroidism were excluded ,the remaining 217 patients were divided into normal FT3 group （n=192） and low FT3 group （n=25） according to FT3 level . General clinical condition and CAG results were compared be-tween two groups . Results：（1 ） Among the 238 CHD patients , there were two cases with hyperthyroidism （0.84% ） ,11 cases with hypothyroidism （4.62% ） ,three cases with subclinical hyperthyroidism （1.26% ） ,five ca-ses with subclinical hypothyroidism （2.10% ） and 25 cases with low T3 syndrome （10.50% ）;（2） Compared with normal FT3 group ,there were significant rise in levels of total cholesterol [TC ,（4.14 ± 1.59） mmol/L vs .（7.33 ± 1.72） mmol/L] ,apoprotein E [ApoE ,（3.91 ± 0.98） mmol/L vs .（4.55 ± 1.52） mmol/L] ,creatinine [Cr ,（97.99 ± 30.85）μmol/L vs .（116.64 ± 43.20） μmol/L] and N terminal pro brain natriuretic peptide [NT-proBNP ,140 （62-462） pg/ml vs .739 （304-4922） pg/ml] in low T3 group , P〈0.01 all;（3） In CHD patients ,percentage of triple-vessel coronary disease in low FT3 group was significantly higher than that of normal FT3 group （76.0% vs . 40.1% , P〈0.01） .Conclusion：Low free thyroxine syndrome is a most frequent thyroid dysfunction in patients with coronary heart disease ,and patients with low free thyroxine are more likely to involve multi-vessel disease .