急性心肌梗死患者甲状腺激素水平与心功能及冠脉病变程度的关系

目的探讨急性心肌梗死患者甲状腺激素水平的变化与心功能和冠脉病变程度的关系。方法64例急性心肌梗死患者，据冠状动脉造影结果分为单支病变组（n=22）和多支病变组（n=42），射血分数（EF）结果分为冠心病非心力衰竭组（n=36）和冠心病心力衰竭组（n=28）。选取同期经冠状动脉造影检查排除冠心病的30例患者为对照组。分别测定各组甲状腺激素水平和高敏C反应蛋白（hs—CRP）等。结果与对照组和冠心病非心力衰竭组相比，冠心病心力衰竭组血清三碘甲状腺原氨酸（TT3）、游离三碘甲状腺原氨酸（FT3）降低（P〈0．05，P〈0．01），反三碘甲状腺原氨酸（rT3）和hs—CRP增高（P〈0．05，P〈0．01）；与单支病变组比较，多支病变患者FT3明显降低（P〈0．01），rT3和hs—CRP增高（P〈0．05）。在校正其他因素后，FT3水平下降与冠脉病变严重程度相关（风险比为0．72，P〈0．05）。结论急性心肌梗死患者的甲状腺激素水平在心功能不全时会有改变，T13，FT3降低，rT3升高，且FT3水平与冠状动脉病变严重程度相关，因此其可作为反映心肌梗死患者病情严重程度的重要指标之一。急性心肌梗死患者hs—CRP升高，反映炎症在急性心肌梗死患者的发生、发展过程中发挥一定的作用。

The relationship between thyroid hormone levels and cardiac function in patients with acute myocardial infarction

Objective To explore the relationship between thyroid hormone levels and cardiac function and severity of coronary disease in patients with acute myocardial infarction （AMI）. Methods Sixty-four patients with AMI were divided into two groups of coronary heart disease （CHD）without heart failure group（ n = 36, EF〉50% ）and CHD with heart failure group（ n = 28, EF 〈 50% ）. At the same time,30 patients without remarkable stenoses confirmed by coronary angiography were used as controls. The serum thyroid hormone levels and high sensitivity C-reactive protein（hs-CRP） were measured in all patients. Of 64 patients with AMI received coro- nary angiography,22 had single vessel disease and 42 had multi vessel diseases. Results The levels of TT3 and FT3 in the CHD patients with heart failure group were significantly lower than that in the CHD patients without heart failure group and the control group（P 〈 0. 05 and P 〈 0.01 ） .The serum level of rT3 and hs-CRP in the CHD patients with heart failure group was higher than that in the CHD patients without heart failure group and the control group（ all P 〈 0.01 ）. The patients with muhi vessel disease had the lower levels of FT3 but higher levels of rT3 and hs-CRP than the patients with single vessel disease. Conclusion The thyroid hormone levels in AMI patients with heart failure are changed： TT3 and FT3 are decreased while rT3 is increased. The FT3 levels are closely correlated with severity of coronary disease. Therefore, serum TT3, FT3 and rT3 levels may be used as important factors for evaluating the severity of AMI. The increased serum levels of hs-CRP may reflect that inflammation play a role in the process of acute myocardial infarction occurrence and development.