血清T3/fT4对急性心肌梗死介入术后并发心力衰竭的预测价值

Predictive value of serum T3 to fT4 radio for heart failure after interventional operation in patients with acute myocardial infarction

目的 研究血清总三碘甲状腺氨酸(total triiodothyronine,T3)/游离甲状腺素(free thyroxine,fT4)对急性心肌梗死(acute myocardial infarction,AMI)介入术后并发心力衰竭(heart failure,HF)的预测价值.方法 选择2017年3月至2018年3月在我院接受治疗的AMI介入患者83例作为对照组,另选同期在我院接受治疗的AMI介入术后并发HF的患者29例作为观察组.对比两组患者的基础资料,生化指标,分析影响AMI介入术后并发HF的危险因素,利用ROC曲线分析血清总T3/fT4对AMI介入术后并发HF的预测价值.结果 观察组的年龄[(71.37±5.24)岁比(60.68±6.92)岁,t=7.585]、心率(heart rate,HR)[(87.13±26.98)次/min比(73.66±25.31)次/min,t=2.425]及心功能分级为Ⅲ~Ⅳ级的比例[62.07%比37.35%,x2=5.336]较对照组明显更高,左心室射血分数(left ventricular ejection fraction,LVEF)[(40.69±9.87)%比(54.38±9.34)%,t=6.696]较对照组明显更低(P<0.05).观察组的脑钠肽(brain natriuretic peptide,BNP)[(986.58±301.65)pg/ml比(454.96±129.37)pg/ml,t=13.055]及fT4[(1.42±0.31)ng/dl比(1.25±0.26)ng/dl,t=2.881]水平较对照组明显更高,而总T3[(89.48±31.06)ng/dl比(103.57±24.33)ng/dl,t=2.492]及总T3/fT4[(59.74±30.38)比(106.58±31.47),t=6.961]水平较对照组明显更低(P均<0.05).Logistic回归分析显示,BNP及总T3/fT4是AMI介入术后并发HF的独立危险因素(OR=1.797、2.436,P<0.05).血清总T3/fT4预测AMI介入术后并发HF的曲线下面积是0.841,诊断阈值是68,灵敏度为78.24%,特异度为73.43%.结论 血清总T3/fT4能够较好地预测AMI介入术后并发心力衰竭的情况,对患者的病情具有一定的研判价值,临床上可以将其引入AMI患者的病情监测过程中,从而更好地服务临床治疗.

Objective To study the predictive value of serum total triiodothyronine (T3)to free thyroxine (fT4)radio for heart failure (HF)after interventional operation in patients with acute myocardial infarction (AMI).Methods 83 cases of AMI patients treated in our hospital from March 2017 to March 2018 were selected as the control group and another 29 patients with HF after AMI interventional operation who were treated in our hospital at the same time were selected as observation group.The basic data and biochemical index of the two groups was compared,and the risk factor of HF after AMI interventional operation was analyzed.The ROC curve was used to analyze the predictive value of serum total T3/fT4 for HF after AMI interventional operation.Results The age of observation group [(71.37±5.24)years old vs.(60.68±6.92)years old,t=7.585],heart rate (HR) [(87.13±26.98 )times/min vs.(73.66±25.31 )times/rain,t=2.425 ]and the proportion of cardiac function grading from grade Ⅲ to IV E62.07%vs.37.35%,2=5.336]were significantly higher than those of control group,left ventricular ejection fraction (LVEF)[(40.69±9.87)%vs.(54.38±9.34)%,t=6.696 ]was significantly lower than that of the control group (P<0.05).The level of brain natriuretic peptide (BNP)[(986.58±301.65)pg/ml vs. (454.96±129.37)pg/ml,t=13.055 ]and fT4[(1.42±0.31 )ng/dl vs.(1.25*0.26)ng/dl,t=2.881 ]in the observation group were significantly higher than those in the control group,while the level of total T3 [(89.48±31.06)ng/dl vs.(103.57±24.33)ng/dl,t=2.492]and total T3/tT4 [(59.7±±30.38)vs.(106.58±31.47),t=6.961 ]were significantly lower than those in the control group (P<0.05).Logistic regression analysis showed that BNP and total T3/fT4 was the independent risk factors for HF after AMI interventional operation (0R=1.797,2.436,P< 0.05).The total T3 to fT4 radio predicted the area under the curve of HF after AMI intervention was 0.841;the diagnostic threshold was 67.45 and the diagnostic threshold was 68.The sensitivity was 78.24%and the specificity was 73.43%.Conclusion Total T3 to fT4 radio can predict the complications of HF after AMI intervention and has certain value in judging the condition of patients.It can be introduced into the monitoring process of patients with AMI in clinic so as to better serve the clinical treatment.