LT_3S与急性心力衰竭患者病情的相关性及其对短期预后的预测价值

Prognostic impact of low triiodothyronine syndrome on acute heart failure patients

目的:观察和分析低三碘甲状腺原氨酸综合征(LT3S)对判断急性心力衰竭(AHF)患者病情危重程度和预测短期内死亡风险的临床价值。方法:入选240例AHF患者,对其进行疾病严重程度指数APACHE II评分,检测其脑钠尿肽(BNP)水平、甲状腺功能。统计患者住院期间病死率,电话随访患者出院6个月后的生存情况。结果:入选240例AHF患者中,并发的患者70例,发生率为29.2%;并发LT3S与并发非LT3S AHF患者间APACHE II评分、BNP水平、住院期间病死率和随访期间病死率差异均有统计学意义[(24±6)vs.(20±6);(784±188)mg/L vs.(697±200)mg/L;17.1%vs.7.6%;11.3%vs.3.4%,均P<0.05]。Cox回归风险比例模型分析:游离三碘甲状腺原氨酸(FT3)水平、APACHE II评分和BNP水平是AHF患者短期内死亡的影响因素(标准偏回归系数=-0.872,HR=0.683,95%CI:0.536-0.847,P<0.05;标准偏回归系数=1.531,HR=1.257,95%CI:1.317-1.864,P<0.05;标准偏回归系数=0.417,HR=0.997,95%CI:0.922-1,P<0.05)。受试者工作特征曲线(ROC)下面积(AUC)分析:APACHE II评分的AUC大于BNP水平和FT3水平的AUC;而BNP水平和FT3水平的AUC间的差异无统计学意义(0.893,95%CI:0.831-0.965;0.720,95%CI:0.640-0.806;0.698,95%CI:0.586-0.751)。结论:AHF患者伴LT3S的诊断,对预测患者的病情危重程度和预后有重要价值。

AIM： To determine the morbidity of low triiodothyronine syndrome in patients with acute heart failure （AHF） and to evaluate the effect of low triiodothyronine syndrome on disease severity and prognosis. METHODS： Thyroid hormone levels, APACHE II scores and BNP levels were assessed in 240 consecutive patients hospitalized for AHF. Mortality during hospitalization was calculated and survival 6 months after discharge was followed-up by telephone inquiry. RESULTS： Seventy （29. 2% ） of the 240 patients with AHF had low thyroid hormone syndrome and the mortality rate during hospitalization and after discharge in this group was higher than in the normal T3 group （17. 1% vs. 7. 6%, P 〈0. 05; 11.3% vs. 3.4%, P 〈0. 05）. APACHE II scores and BNP levels were higher in low thyroid hormone syndrome group compared with those in normal T3 group [24±6 vs. 20±6; （784 ± 188） mg/L vs. （697±200） mg/L]. In a multivariate Cox proportional hazards model, FT3 levels, APACHE II scores and BNP levels were independent predictors of early mortality in patients in AHF （ HR = 0. 683, 95% CI： 0. 536 - 0. 847, P〈O. 05; HR=1.257, 95%CI： 1.317-1.864, P〈0.05; HR =0.997, 95%CI： 0.922-1, P〈 0. 05）. Area under the curve for APACHE II scores was higher than for FT3 and BNP levels. However,there was no significant difference in area under the curve between FT3 and BNP levels （0. 893, 95% CI： 0. 831 -0.965; 0.720, 95%CI： 0. 640-0. 806; 0.698, 95%CI： 0. 586-0.751）. CONCLUSION： Diagnosis of AHF complicated with low T3 syndrome is important in evaluating disease severity and predicting the prognosis.