心力衰竭患者心功能分级、血清N末端脑钠肽前体与甲状腺激素水平的相关性研究

Cardiac function,serum N-terminal pro-brain natriuretic peptide and thyroid hormone levels in patients with heart failure：a correlation study

目的 探讨心力衰竭患者心功能分级、血清N末端脑钠肽前体（NT-proBNP）与甲状腺激素水平的关系.方法 收集本院2016年1月至2017年1月收治的心力衰竭急性发作患者189例,包括慢性心力衰竭（CHF）急性发作患者127例、新发急性心力衰竭患者62例,以同期临床诊断无心力衰竭住院治疗的心血管病患者234例作为对照.3组患者进行心功能美国纽约心脏病学会（NYHA）分级,检测血清肌酐、空腹血糖、血脂、血清甲状腺激素和NT-proBNP水平.分析心力衰竭患者甲状腺激素水平与NT-proBNP、心功能分级的相关性.结果 入选心力衰竭患者189例按NYHA分级分为Ⅱ级16例、Ⅲ级135例、Ⅳ级38例,对照组患者NYHA分级均为Ⅰ级.对照组甲状腺激素减低发生率为17.1%（40/234）,心力衰竭组甲状腺激素减低发生率为58.7%（111/189）,组间比较差异具有统计学意义（P＆lt;0.05）.心力衰竭组（n=189）甲状腺激素减低患者111例中,心功能NYHA分级Ⅱ级4例（25.0%,4/16）、Ⅲ级79例（58.5%,79/135）、Ⅳ级28例（73.7%,28/38）;随着心功能分级加重,甲状腺激素减低的发生率逐渐增加.与NYHA分级Ⅱ级比较,NYHA分级Ⅲ级和Ⅳ级的心力衰竭患者血清游离三碘甲状腺原氨酸（FT3）水平显著降低,而促甲状腺激素（TSH）、NT-proBNP水平均显著增加（均P〈0.05）.心力衰竭患者血清NT-proBNP水平与心功能分级呈正相关（rs=0.705,P〈0.05）.心力衰竭患者血清FT3与NT-proBNP水平呈负相关（r=-0.173,P〈0.05）.按年龄将心力衰竭患者分为3组,随着年龄的增长血清NT-proBNP水平逐渐增高,二者呈正相关（rs=0.257,P〈0.05）.结论 心力衰竭患者甲状腺激素减低发生率高,结合血清NT-proBNP水平及甲状腺功能测定有助于评估心力衰竭的严重程度及预后.

Objective To investigate the relationship among the cardiac function,serum N-terminal pro-brain natriuretic peptide（NT-proBNP）and thyroid hormone levels in patients with heart failure. Methods A total of 189 patients with acute onset of heart failure treated in our hospital between January 2016 and January 2017 were included in this study,comprising 127 patients with acute aggravation of chronic heart failure（CHF）and 62 patients with newly diagnosed acute heart failure. A contemporary cohort of 234 hospitalized cardiovascular disease patients without heart failure was included as controls. The three groups of patients underwent cardiac function classification according to the New York Heart Association （NYHA）guideline. Serum creatinine,fasting blood glucose,blood lipids,serum thyroid hormones and NT-proBNP levels were measured. The correlations between thyroid hormone and NT-proBNP levels and cardiac function in patients with heart failure were analyzed. Results According to the NYHA classification,189＆amp;nbsp;patients with heart failure comprised 16 cases of grade Ⅱ,135 of grade Ⅲ and 38 of grade Ⅳ. The NYHA classification was grade Ⅰ in all the control group. Thyroid hormone was reduced in 17.1%（40/234）of the patients in the control group,compared with 58.7%（111/189） in patients with heart failure,and the difference between two groups was statistically significant（P〈0.05）. Of the heart failure patients（n=189）, the NYHA classification of 111 patients with reduced thyroid hormone levels was grade Ⅱ in 4 cases （25.0%,4/16）,grade Ⅲ in 79 cases（58.5%,79/135）and grade Ⅳ in 28 cases（73.7%,28/38）. Higher grade of cardiac function was associated with greater incidence of thyroid hormone reduction. Compared with the NYHA grade Ⅱ patients,those with grades Ⅲ or Ⅳ had significantly lower levels of serum free triiodothyronine（FT3）,and higher levels of thyroid-stimulating hormone（TSH）and NT-proBNP（all P〈0.05）. Serum NT-proBNP levels were positively correlated with cardiac function in patients with heart failure （rs=0.705,P〈0.05）. There was a negative correlation between serum FT3 and NT-proBNP levels in patients with heart failure（r=-0.173,P〈0.05）. When the heart failure patients were stratified by three age groups, the levels of serum NT-proBNP were found to increased with age by a positive correlation （rs=0.257,P〈0.05）. Conclusion The occurrence of thyroid hormone reduction is highly probable in patients with heart failure. Combined detection of serum NT-proBNP and thyroid function is helpful to assess the severity and prognosis of heart failure.