慢性心力衰竭患者甲状腺激素水平与远期生存率的相关分析

目的探讨慢性心力衰竭（chronic heart failure,CHF）患者甲状腺激素水平与远期生存率的相关性。方法入选355例CHF患者,入院后测定甲状腺激素水平、血糖血脂、行心脏超声检查并进行远期随访,比较各组指标并分析远期生存率。结果将人群FT₃值分为4分位数,位于下1/4位点者的住院时间、白细胞、中性粒细胞百分比、尿酸、肌酐、促甲状腺激素（thyroid stimulating hormone,TSH）明显高于上1/4位点者（P<0.05）,而红细胞、总蛋白、白蛋白、三酰甘油（triglyceride,TG）、左室射血分数（left ventricular ejection fraction,LVEF）、游离甲状腺素（FT₄）、血清钠、血清钙明显低于上1/4位点者（P<0.05）。Cox模型分析显示,在校正多因素后,游离三碘甲状腺原氨酸（FT₃）是影响CHF患者全因死亡率和心源性死亡率的独立危险因子,FT₃每下降1 pmoL/L,死亡风险增加49.8%,其次是LVEF和年龄。结论 FT₃是影响CHF患者全因死亡率和心源性死亡率的独立危险因子,低FT₃状态与慢性心力衰竭患者远期生存率相关。

Correlation between thyroid hormone levels and long-term survival in patients with chronic heart failure

Objective To evaluate the correlation between thyroid hormone levels and long-time survival in patients with chronic heart failure （CHF）. Methods A total of 355 CHF patients were included in this study. Thyroid hormone profile, serum lipid and glucose were measured, echocardiography was examined. The correlation of thyroid hormone levels with long-time survival was analyzed. Results Quartiles of serum free triiodothyronine （~F3 ） levels were computed. Compared with those in the highest quartile of FT3, length of hospital stay, WBC, neutrophils percentage, uric acid, serum creatinine and TSH were higher in the lowest quartile group （P 〈 0.05 ）, but RBC, total protein, albumin, triglyceride （TG）, left ventricular ejection fraction（ LVEF）, FF4, serum sodium and serum calcium were lower （ P 〈 0.05 ）. Cox regression displayed that FT3 was an independent factor associate with all-cause mortality and cardiac mortality, followed by LVEF and age. An decrease of 1 pmol/L in FT3 was associated with an increase in mortality risk of 49.8 %. Conclusion FF3 is an independent risk factor for all-cause and cardiac mortality and low FT3 state is related to long-time survival in chronic heart failure patients.