甲状腺功能紊乱对急性心肌梗死预后的影响

Effect of thyroid disorders on prognoses of acute myocardial infarction patients

目的探讨急性心肌梗死(AMI)时甲状腺功能紊乱的发生情况及对预后的影响。方法入选463例AMI患者,入院次日测定甲状腺激素水平。观察住院期间心血管事件发生情况并进行远期随访。结果 AMI患者中甲状腺功能正常(功能正常组)239例(51.6%),非甲状腺性病态综合征(NTIS,NTIS组)168例(36.3%),亚临床甲状腺功能亢进症40例(8.6%),亚临床甲状腺功能减退6例(1.3%),甲状腺功能亢进5例(1.1%),甲状腺功能减退5例(1.1%)。NTIS组在住院期间的充血性心力衰竭、心源性休克和死亡的发生率均显著高于功能正常组(P值分别<0.05、0.01)。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)仍是AMI患者远期累积死亡风险的独立预测因子。FT3每降低1pmol/L,死亡风险增加59.8%。结论 AMI患者急性期存在甲状腺功能紊乱,NTIS与AMI患者近期和远期病死率相关。

Objective To evaluate the influence of thyroid disorders on the incidence and prognosis of acute myocardial infarction(AMI)patients.Methods A total of 463 AMI patients were included in the present study.The thyroid hormone levels were determined in all patients on the next day of admission.The patients were divided into different groups and the cardiac events were observed during hospitalization.Results Among the 463 patients,239(51.6%)had normal thyroid hormone level,and 168(36.3%)had non-thyroidal illness syndrome.There were 40(8.6%)patients with subclinical hyperthyroidism and 6(1.3%)with subclinical hypothyroidism.Hyperthyroidism and hypothyroidism were both found in 5 patients.Compared with the euthyroid group,the incidences of congestive heart failure,origin of shock incidence,and in-hospital death increased in the non-thyroidal illness syndrome group(P<0.05,0.01).Multivariate cox regression displayed that FT3 was an independent factor associated with long-term mortality.A decrease of 1 pmol/L in FT3 was associated with an increased risk of death by 59.8%.Conclusion Thyroid disorder is frequently seen in patients with acute myocardial infarction.NTIS is significantly correlated with the short-time and long-time prognoses of AMI patients.