冠心病患者甲状腺功能及FT3与冠状动脉病变关系的研究

Relationship among thyroid function,FT3 level and coronary artery disease in patients with coronary heart disease

目的：探讨冠心病患者甲状腺功能情况及游离甲状腺素（FT3）水平与冠脉病变的关系。方法：选择2012年至2014年期间入住我院，经冠脉造影证实的238名冠心病患者，分析其甲状腺功能情况；在排除甲亢、亚临床甲亢，甲状腺功能（甲减）、亚临床甲减后，其余217例患者根据FT3水平被分为正常FT3组（192例）和低FT3组（25例），比较两组患者一般临床情况和冠脉造影结果。结果：（1）238名患者中甲亢2例（0.84％），甲减11例（4.62％），亚临床甲亢3例（1.26％），亚临床甲减5例（2.10％），低T3综合征25例（10.50％）；（2）与正常FT3组比较，低FT3组患者总胆固醇[TC ，（4.14±1.59） mmol/L比（7.33±1.72） mmol/L]、载脂蛋白 E [ApoE ，（3.91±0.98） mmol/L比（4.55±1.52） mmol/L]、肌酐[Cr ，（97.99±30.85）μmol/L比（116.64±43.20）μmol/L]、N末端B型利钠肽原[NT-proBNP ，140（62-462） pg/ml比739（304-4922） pg/ml]水平显著升高（P均＜0.01）；（3）冠心病患者中FT3降低的患者合并三支病变的比例显著高于正常 FT3组（76.0％比40.1％， P＜0.01）。结论：低游离甲状腺素综合征是冠心病患者最常见的甲状腺功能异常，游离甲状腺素水平降低的患者更容易多支血管受累。

Objective：To explore the relationship among thyroid function ,free thyroxine （FT3） level and coronary artery disease in patients with coronary heart disease （CHD） .Methods ：A total of 238 CHD patients ,who hospital-ized in our hospital from 2012 to 2014 and were proved by coronary angiography （CAG） ,were selected .Their thy-roid function was analyzed .After patients with hyperthyroidism ,hypothyroidism ,subclinical hyperthyroidism and subclinical hypothyroidism were excluded ,the remaining 217 patients were divided into normal FT3 group （n=192） and low FT3 group （n=25） according to FT3 level . General clinical condition and CAG results were compared be-tween two groups . Results：（1 ） Among the 238 CHD patients , there were two cases with hyperthyroidism （0.84% ） ,11 cases with hypothyroidism （4.62% ） ,three cases with subclinical hyperthyroidism （1.26% ） ,five ca-ses with subclinical hypothyroidism （2.10% ） and 25 cases with low T3 syndrome （10.50% ）;（2） Compared with normal FT3 group ,there were significant rise in levels of total cholesterol [TC ,（4.14 ± 1.59） mmol/L vs .（7.33 ± 1.72） mmol/L] ,apoprotein E [ApoE ,（3.91 ± 0.98） mmol/L vs .（4.55 ± 1.52） mmol/L] ,creatinine [Cr ,（97.99 ± 30.85）μmol/L vs .（116.64 ± 43.20） μmol/L] and N terminal pro brain natriuretic peptide [NT-proBNP ,140 （62-462） pg/ml vs .739 （304-4922） pg/ml] in low T3 group , P〈0.01 all;（3） In CHD patients ,percentage of triple-vessel coronary disease in low FT3 group was significantly higher than that of normal FT3 group （76.0% vs . 40.1% , P〈0.01） .Conclusion：Low free thyroxine syndrome is a most frequent thyroid dysfunction in patients with coronary heart disease ,and patients with low free thyroxine are more likely to involve multi-vessel disease .