亚临床甲状腺功能紊乱对急性心力衰竭患者远期预后的影响

Long-term influence of subclinical thyroid dysfunction on acute heart failure patients

目的：评价亚临床甲状腺功能紊乱对急性心力衰竭患者远期预后的影响。方法纳入420例急性心力衰竭（AHF）患者。入院24 h内测定甲状腺激素、脑利钠肽（BNP）并行超声心动图检查。应用Logistic回归和Cox风险模型分析亚临床甲状腺功能紊乱与全因死亡的关系。结果在6～49个月随访期间，119例（28．3％）患者死亡，甲状腺功能正常组与亚临床甲状腺功能减退（SHypo）组、亚临床甲状腺功能亢进（SHyper）组的全因死亡率存在差异（分别为26．5％、51．1％、34．5％，log－rankχ2＝6．172，P＝0．046）。多因素Cox风险模型分析显示，年龄、BNP、左室射血分数、甲状腺激素、游离甲状腺激素、SHypo （危险比：1．147，95％ CI：0．971～1．352， P＝0．012）是AHF患者全因死亡的预测因素。血清三碘甲状腺原氨酸，游离三碘甲状腺原氨酸和SHyper不是全因死亡的预测因素。结论 SHypo是AHF患者的全因死亡独立预测因素，而SHyper不是全因死亡预测因素。

Objective To evaluate the long-term influence of subclinical thyroid dysfunction on acute heart failure （ AHF ） patients. Methods A total of 420 AHF patients were enrolled in this study.Thyroid function ,B-brain natriuretic peptide （ BNP） and echocardiogram were tested within 24 h after admission.Relationship between subclinical thyroid dysfunction and all -cause death was analyzed by Logistic regression and Cox risk model. Results During follow-up time of 6~49 months,119 patients（28.3%） died.All-cause mortality was significantly different between euthyroidism group , subclinical hypothyroidism （SHypo）group and subclinical hyperthyroidism （SHyper） group（26.5%,51.1%and 34.5%,respectively, log-rank χ2 =6.172,P =0.046）.The multivariate Cox hazard analysis demonstrated that age,BNP,left ventricular ejection fractions,thyroxine,free thyroxine,and SHypo （hazard ratio：1.147,95% CI：0.971-1.352,P =0.012） were predictors of all-cause mortality.While triiodothyronine,free triiodothyronine and SHper were not predictors of all-cause mortality. Conclusions SHypo is an independent predictor for long-term all-cause mortality among AHF patients .SHper does not show the predictive value .