促甲状腺激素对冠心病患者行经皮冠状动脉介入术预后的影响

Influence of thyroid-stimulating hormone within reference range on patients with coronary heart disease after percutaneous coronary intervention

目的研究正常范围内不同浓度梯度的促甲状腺激素(thyroid-stimulating hormone,TSH)对冠心病患者行经皮冠状动脉介入术(percutaneous coronary interventions,PCI)预后的影响及其临床意义。方法回顾性纳入1 002例行PCI且TSH处于正常范围内(0.30~4.20μIU/m L)的冠心病患者,将受试者分为3组:TSH正常低值组(0.30~1.60μIU/m L,387例)、TSH正常中值组(1.61~2.90μIU/m L,413例)、TSH正常高值组(2.91~4.20μIU/m L,202例),随访时间1年,终点事件是全因死亡,并统计出血事件和再入院事件。结果正常低值组全因死亡事件6例,全因死亡率1.55%;正常中值组全因死亡事件8例,全因死亡率1.94%;正常高值组全因死亡事件10例,全因死亡率4.95%;各组之间比较差异有统计学意义(P<0.05)。正常低值组再出血事件13例,再出血率3.36%;正常中值组再出血事件14例,再出血率3.39%;正常高值组再出血事件16例,再出血率7.92%;各组之间比较差异有统计学意义(P<0.05)。正常低值组再入院事件38例,再入院率9.82%;正常中值组再入院事件27例,再入院率6.54%;正常高值组再入院事件15例,再入院率7.43%;各组之间比较差异无统计学意义(P>0.05)。Logistic回归分析显示正常高值的TSH(OR=1.48)是PCI术后全因死亡的危险因素,同时正常高值的TSH(OR=1.47)是PCI术后出血的危险因素。生存分析也进一步证明正常高值的TSH是PCI术后全因死亡的危险因素(P<0.05)。结论 TSH水平越高,全因死亡事件、再出血事件的发生率越高;正常高值的TSH是经皮冠状动脉介入治疗的全因死亡和出血事件的危险因素。

Objective To observe the prognosis value of thyroid-stimulating hormone（ TSH） within reference range in patients with coronary heart disease（ CHD） after percutaneous coronary intervention（ PCI）and its clinical significance. Methods One thousand and two patients with CHD,who received PCI and had TSH in the normal range（ 0. 3 ~ 4. 2 μIU/m L）,were enrolled. The patients were divided into 3 groups： Lownormal TSH group（ 0. 30 ~ 1. 60 μIU/ml,n = 387）,the middle-normal TSH group（ 1. 61 ~ 2. 90 μIU/m L,n = 413）,and the high-normal TSH group（ 2. 91 ~ 4. 20 μIU/m L,n = 202）. All of them were followed up for 1 year,and primary end point was all-cause mortality. Peri-PCI bleeding and readmission were also recorded. Results The low-normal group experienced an all-cause mortality rate of 1. 55%,a peri-PCI bleeding rate of 3. 36%,and a readmission rate of 9. 82%. The middle-normal group had an all-cause mortality rate of 1. 94%,a peri-PCI bleeding rate of 3. 39%,and a readmission rate of 6. 54%. The highnormal group experienced an all-cause mortality rate of 4. 95%,a peri-PCI bleeding rate of 7. 92%,and a readmission rate of 7. 43%. There were significant differences in one-year all-cause mortality and peri-PCI bleeding among the 3 groups（ all P〈0. 05）,and there was no significant difference in the readmission among them（ P〈0. 05）. Logistic regression analysis showed that TSH in the upper reference range was a risk factor in one-year all-cause mortality（ OR = 1. 48,P〈0. 05） and peri-PCI bleeding（ OR = 1. 47,P〈0. 05）. Survival analysis also showed that TSH in the upper reference Limit was a risk factor in one-year all-cause mortality（ RR =1. 566,P〈0. 05）. Conclusion TSH in the upper reference Limit is an independence risk factor in one-year all-cause mortality and peri-PCI bleeding in the patients with CHD after PCI.