甲状腺激素联合B型脑钠肽检测对急性心力衰竭患者预后的影响

Prognosis value of thyroxin with B-type natriuretic peptide for patients with acute heart failure

目的探讨甲状腺激素联合B型脑钠肽(BNP)检测对急性心力衰竭(AHF)患者预后的影响。方法纳入AHF患者619例,入院后测定甲状腺激素、BNP。根据患者随访结果分为死亡组和生存组。应用Cox风险模型、ROC曲线和Kaplan-Meier生存曲线分析甲状腺激素和BNP与全因死亡的关系。结果低T3综合征(LT3S)发生率为44.4%。在(19±13)个月随访期间,死亡204例(32.9%)。Cox风险模型分析显示年龄(HR=1.033,95%CI:1.017~1.049,P<0.01),游离三碘甲状腺原氨酸(FT3)(HR=0.489,95%CI:0.384~0.628,P<0.01)、BNP(HR=2.136,95%CI:1.114~4.126,P<0.01)和肌酐(HR=1.002,95%CI:1.001~1.003,P<0.05)是全因死亡的独立危险因素。根据FT3(≤2.72pmol/L)和BNP(>2 230pg/ml)的切点,Kaplan-Meier生存曲线分析显示低FT3(≤2.72 pmol/L)/高BNP(>2 230pg/ml)组患者全因死亡风险最高(HR=7.247,95%CI:3.993~13.152,P<0.01)。结论 FT3是AHF患者全因死亡的独立危险因素,低FT3/高BNP患者远期预后更差。

Objective To assess the prognostic value of thyroxin combined with B-type natriuretic peptide （BNP） in patients with acute heart failure（AHF）.Methods A total of 619 AHF patients were included in this study.Thyroid hormone profile,BNP were measured within 24h after admission.The patients were divided into survival group and non-survival group.Using Cox hazards model,receiver operating characteristic curve and Kaplan-Meier survival analysis,the correlation of thyroid hormone levels and BNP with all-cause mortalities of patients was assessed.Results The incidence of low triiodothyronine syndrome （LT3S） in patients with AHF was 44.4%.At the median follow-up time of 19 ± 13 months,204 patients （32.9%） were died.Multivariate Cox regression analysis showed that age （HR=1.033,95% CI：1.017-1.049,P〈0.01）,FT3 （HR=0.489,95% CI：0.384-0.628,P〈0.01）,BNP （HR=2.136,95% CI：1.114-4.126,P〈0.01） and serum creatinine （HR=1.002,95%CI：1.001-1.003,P〈0.05） were independent predictors for all-cause mortality.Based on the cut-off value of FT3（≤ 2.72 pmol/L） and BNP（〉2 230 pg/ml）,Kaplan-Meier analysis provided the significant prognostic information with the highest risk of all-cause death （HR=7.247,95%CI：3.993-13.152,P〈0.01） in the low FT3 （≤2.72 pmol/L）/high BNP （〉2 230pg/ml） group.Conclusion FT3 levels appear to be independent predictor for all-cause mortalities among AHF patients,and low FT3 and high BNP levels predicts a worse long-term outcome.