探讨甲状腺激素与慢性心力衰竭患者心房颤动发生率的相关性

Relationship Between Thyroid Hormone and Atrial Fibrillation Prevalence in Patients With Chronic Heart Failure

目的：探讨甲状腺激素与慢性心力衰竭（心衰）患者心房颤动（房颤）发生率的相关性。方法：为回顾性研究。选取2011-01-01至2012-10-01期间收住我院的非瓣膜性心脏病致慢性心衰患者共322例,根据既往有无房颤史及入院后心电图检查分为房颤组187例和窦性心律组135例。入院后24 h内记录患者病史,测定血清游离甲状腺素（FT4）、游离三碘甲状腺原氨酸（FT3）、促甲状腺激素（TSH）、低密度脂蛋白胆固醇（LDL-C）水平;并行十二导联心电图及超声心动图检查,分析影响心衰患者发生房颤的相关因素。结果：与窦性心律组比较,房颤组的FT4水平明显增加[以中位数（M）及四分位数间距（Q1,Q3）表示,14.52（12.74,15.85）pmol/L vs 13.11（11.68,14.85）pmol/L,P〈0.001],差异有统计学意义;而FT3水平两组比较[4.06（3.76,4.44）pmol/L vs 4.1（3.80,4.52）pmol/L,P=0.250],差异无统计学意义。Spearman秩相关性分析发现：FT4水平与左心房内径呈正相关（r=0.134,P=0.016）,FT3与LDL-C水平呈正相关（r=0.235,P〈0.001）,FT3与年龄呈负相关（r=-0.268,P〈0.001）。将FT4以连续变量引入Logistic回归方程结果显示：FT4水平[比值比（OR）：1.227,95%可信区间（CI）1.112-1.354,P〈0.001]、左心房内径[OR：1.154,95%CI（1.105-1.205）,P〈0.001]、年龄[OR：1.038,95%CI（1.012-1.064）,P=0.003]、心衰持续时间[OR：1.111,95%CI（1.021-1.209）,P=0.015]、LDL-C水平[OR：0.689,95%CI（0.493-0.963）,P=0.029]与心衰患者房颤的发生率相关。结论：高FT4水平可能增加了慢性心衰患者发生房颤的风险。

Objective： To investigate the impact of thyroid hormone on atrial fibrillation （AF） prevalence in patients with chronic heart failure （CHF）. Methods： A total of 322 non-valvular heart disease CHF patients treated in our hospital from 2011-0-01 to 2012-10- 01 were retrospectively studied. Based on previous history and the ECG at admission, the patients were divided into 2 groups： AF group, n=187 and Sinus rhythm group, n=135. The profile of serum levels of free thyroxine （FT4）, flee triiodothyronine （FT3）, hyroid stimulating hormone （TSH） and LDL-C were examined within 24 hours of admission; 12 lead ECG and echocardiography were conducted to analyze the related factor for AF occurrence. Results： Compared with Sinus rhythm group, AF group had increased FT4 level as 14.52 （12.74, 15.85） pmol/L vs 13.11 （11.68, 14.85） pmol/L, P〈0.001, while FT3 level was similar between 2 groups as 4.06 （3.76, 4.44） pmol/L vs 4.1 （3.80, 4.52） pmol/L, P=0.250. Spearman related analysis indicated that FT4 level was positively related to left atrial dimension （LAD） （r=0.134, P=0.016）, FT3 level was positively related to LDL-C （r=0.235, P〈0.001） and negatively related to age （r=-0.268, P〈0.001）. Taking FT4 as the continuous variable, Logistic regression analysis indicated that FT4 level [OR=1.227, 95% CI （1.112-1.354）, P〈0.001], LAD [OR=1.154, 95% CI （1.105-1.205）, P〈0.001], age [OR=1.038, 95% CI （1.012-1.064）, P=0.003], CHF duration [OR=1.111, 95% CI （1.021-1.209）, P=0.015], LDL-C level [OR=0.689, 95% CI （0.493-0.963）, P=0.029] wererelated to AF prevalence in CHF patients. Conclusion： High serum level of FT4 may increase the risk AF occurrence in CHF patients.