老年心力衰竭患者甲状腺激素和血浆N末端原脑钠肽的变化及其与预后的关系

Study on relationship between changes in blood levels of thyroid hormones and N-terminal pro-brain natriuretic peptide and prognosis of elderly patients with congestive heart failure

目的探讨老年慢性心力衰竭患者心功能与血清甲状腺激素、血浆N末端原脑利钠肽(NT-proBNP)的变化及对预后的影响。方法选择60例老年慢性心力衰竭患者,根据NYHA心功能Ⅱ、Ⅲ、Ⅳ级分为2组,分别测定血NT-proBNP、血清三碘甲状腺原氨酸(T3),甲状腺素(T4),游离三碘甲状腺原氨酸(FT3),游离甲状腺素(FT4)及促甲状腺素(TSH)水平。比较2组间甲状腺激素变化及NT-proBNP变化。根据住院期间是否发生心血管事件(恶性心律失常、心衰反复或加重、心肌梗死、死亡)分为事件组和非事件组。结果心功能Ⅳ级患者与心功能Ⅱ级、Ⅲ级患者比较,T3和FT3明显降低,(P<0.05),NT-proBNP随着心功能不全加重而升高(P<0.05)。而T4、FT4、TSH均无明显变化(P>0.05)。心脏事件组与非事件组比较:NT-proBNP明显升高,T3和FT3明显降低,(P<0.05)。结论甲状腺激素、NT-proBNP与老年慢性心力衰竭患者的心功能严重程度有关,影响预后。

Objective To study the relationship between changes in blood levels of thyroid hormones and N - terminal pro - brain natriuretic peptide and prognosis of elderly patients with congestive heart failure. Methods Blood levels of NT - proBNP, T3, T4, FT3, FT4 and TSH were measured in 60 elderly patients with congestive heart failure. These patients were divided into 2 groups according the occurrence of cardiovascular events （ such as severe arrhythmia, worsening of heart failure, myocardial infarction and death） and without events. Results The blood levels of T3 and FF3 were significantly decreased in elderly patients with congestive heart failure （ with NYHA classification class Ⅳ ） compared with those of patients in control group （ with NYHA classification class Ⅲ - Ⅱ ） （ P 〈 0. 05 ）. Blood level of NT - proBNP was increased following the increase of degree of chronic heart failure. The incidence rate of cardiovascular events in elderly patients with heart failure was related to lower blood levels of T3 and FY3 and higher blood level of NT - proBNP. Conclusion Blood levels of thyroid hormones and NT - proBNP were related to the occurrence of cardiac dysfunction and cardiac events. Detection of blood levels of thyroid hormones and NT - proBNP has important clinical significance in evaluating the prognosis of elderly patients with heart failure.