慢性心力衰竭伴非甲状腺性病态综合征的研究

目的 观察甲状腺性病态综合征(NTIS)在慢性心力衰竭(CHF)患者中的发病情况及与死亡率的关系.方法 入选323例CHF患者,入院后测定甲状腺激素水平、血清电解质浓度并行超声心动图检查,根据甲状腺功能分组,比较两组血清钠浓度、住院时间和住院期间死亡率,分析相关影响因素.结果 323例CHF患者中81例(25.08%)伴NTIS.NTIS组住院期间死亡率、住院时间显著高于甲状腺功能正常组(P均<0.01),而血清钠、左心室射血分数(LVEF)低于甲状腺功能正常组(P均<0.01);左心室射血分数、血清游离三碘甲状腺原氨酸(FT3)与住院期间死亡率明显相关(P<0.01),FT3是影响住院期间死亡率的独立危险因素,且为住院时间最主要的影响因子;FT3水平与血清钠浓度和左心室射血分数显著相关(P<0.01).结论 NTIS在CHF患者中常见,低T3状态的CHF患者低钠血症的发病率也明显升高.FT3是影响住院期间患者死亡率的独立危险因素.

Research of chronic heart failure complicate with nonthyroidal illness syndrome

Objective To evaluate the incidence of nonthyroidal illness syndrome （NTIS）in chronic heart failure （CHF） patients and its effect on mortality. Methods A total of 323 CHF patients were included in this study. Thyroid hormone profile, serum electrolytes concentration and cardial ultrasound were determined after admission, and grouped according to thyroid hormone levels. Serum sodium concentrations, length of hospital stay and in-hospital mortality were compared in both groups,and the related factors were analysed. Results Among the 323 patients,81 （25.08%） were complicated with NTIS. Compared with euthyroid group, in-hospital mortality and length of hospital stay increased （ both P 〈 0. 01 ） and the serum sodium and left ventricular ejection fraction （ LVEF ） significantly lowered in congestive heart failure with NTIS patients （ P 〈 0. 01 ）. LVEF and free triiodothyronine （ FT3 ） level were significantly associated with in-hospital mortality（ P 〈 0. 01 ）. FT3 concentration was the independent risk factor for hospital mortality and the most important influential factor for length of hospital stay. FT3 levels was significantly related to serum sodium concentration and LVEF（ P 〈 O. O1 ）. Conclusions NTIS is common in CHF patients and the incidence of hyponatremia in these patients was significantly increased. FT3 was an independent risk factor for hospital mortality.