急性心肌梗死患者甲状腺激素水平与冠状动脉病变严重程度相关性研究

目的:探讨急性心肌梗死患者甲状腺激素水平与冠状动脉病变严重程度及心脏功能的关系。方法:选取甲状腺功能正常的急性心肌梗死患者341例,检测促甲状腺激素(TSH)水平,游离三碘甲状腺原氨酸(FT3),游离四碘甲状腺原氨酸(FT4),血脂水平,高敏C反应蛋白,统计住院期间严重心血管事件率(严重心律失常、心源性休克、急性左心功能衰竭及死亡)。超声心动图检查左心室射血分数,左心室舒张功能。根据FT3三分位分为FT3 1.16～2.25 pg/ml组113例、FT3 2.26～2.81 pg/ml组114例、FT3 2.82～4.02 pg/ml组114例。224例行冠状动脉造影评估冠状动脉病变严重程度患者,根据病变血管支数分为单支病变患者70例和多支(≥2支)病变患者154例。结果:FT3 2.82～4.02 pg/ml组与FT3 1.16～2.25 pg/ml组比高敏C反应蛋白明显下降、左心室舒张功能指标E/A(左心室舒张早期二尖瓣口血液流速/左心室舒张末期流速)值增高、严重心血管事件率下降,差异有统计学意义(P<0.05或0.01)。多支病变患者TSH、FT4、FT3均较单支病变患者降低,但只有FT3差异有统计学意义(P<0.05)。Logis-tic多元回归分析显示,在校正了年龄、性别、吸烟史及高血压史、糖尿病史、血脂水平、高敏C反应蛋白水平后,FT3下降仍是冠状动脉多支病变独立危险因素(风险比为0.65,P<0.05)。结论:甲状腺功能正常的急性心肌梗死患者FT3水平与心脏舒张功能、严重心血管事件率及冠状动脉病变严重程度密切相关,FT3可作为反映心肌梗死患者病情的一项重要指标。

Relationship Between Thyroid Hormone Level and the Severity of Coronary Disease in Patients With Acute Myocardial Infarction

Objective:To explore the relationship between thyroid hormone level and the severity of coronary disease with cardiac function in patients of acute myocardial infarction(AMI). Methods:We studied 341 AMI patients with normal thyroid function.The levels of thyroid stimulating hormone(TSH),free tri-iodothyronine(FT3),free tetra-iodothyronine(FT4),high sensitivity C-reactive protein(hs-CRP) and blood lipids were examined in all patients.According to FT3 level,the patients were divided into three groups as FT3 at 1.16~2.25 pg/ml group,n=113,FT3 at 2.26～2.81 pg/ml group,n=114,and FT3 at 2.82～4.02 pg/ml group,n=114.A total of 224 patients received coronary angiography,70 of them had single vessel disease and 154 had multi vessel disease.LVEF and E/A ratio were measured by color Doppler echocar-diography to evaluate the cardiac function.Severe cardiac events during hospitalization were recorded. Results:The patients in FT3 at 2.82～4.02 pg/ml group had lower hs-CRP,higher E/A ratio and decreased rate of severe cardiac events than those in FT3 at 1.16~2.25 pg/ml group,P<0.05 or P<0.01.The patients with multi vessel disease had the lower levels of TSH,FT4 and FT3 than the patients with single vessel disease,while only FT3 level had the statistic difference,P<0.05.Multiple Logistic regression analysis presented that with adjusted age,gender,history of diabetes and smoking,hypertension,blood lipids and hs-CRP,decreased FT3 was the independent risk factor for multi coronary vessel disease(OR 0.65,P<0.05). Conclusion:In AMI patients with normal thyroid function,FT3 level had closely related to cardiac diastolic function,adverse cardiovascular events and the severity of coronary disease.FT3 level might be used as an important factor for evaluating the severity of AMI.