游离三碘甲状腺原氨酸降低对肥厚型心肌病患者远期预后的影响

Long-term prognostic value of lowering in free triiodothyronine in patients with hypertrophiccardiomyopathy

目的观察游离三碘甲状腺原氨酸（FT3）水平对肥厚型心肌病患者长期预后的影响。 方法回顾性分析中国医学科学院阜外医院2009年10月至2013年12月入院确诊为肥厚型心肌病患者。所有患者随访至2016年12月。根据患者FT3水平三分位数，分为FT3≤4.28 pmol/L组（335例），FT3〉4.28~〈4.79 pmol/L组（310例），FT3 4.79~6.30 pmol/L组（337例）。研究终点为全因死亡和心脏移植联合终点。采用Kaplan-Meier法绘制生存曲线，利用单因素及多因素Cox回归分析3组患者生存率的差异。 结果患者随访时间为（53.8±14.1）个月，期间共有39例（4.0%）患者发生全因死亡和心脏移植联合终点事件，其中FT3≤4.28 pmol/L组的事件率为7.8%, FT3〉4.28~〈4.79 pmol/L组的事件率为2.9%, 4.79~6.30 pmol/L组的事件率为1.2%。Cox生存分析显示，FT3≤4.28 pmol/L是全因死亡和心脏移植的联合终点的独立危险因素（HR 8.83, 95% CI 1.115~69.905, P=0.039）。 结论低FT3是肥厚型心肌病预后不良的独立危险因素，FT3水平能够预测肥厚型心肌病患者远期预后。

ObjectiveTo determine whether thyroid hormone （TH） level could also be an independent and incremental predictor of adverse events in patients with hypertrophic cardiomyopathy （HCM）. MethodsA total of 982 consecutive patients with HCM at the National Center for Cardiovascular Diseases （China） from October 2009 to December 2013 were included in the present study, and followed up till the end of December 2016. The patients were divided into three groups according to the levels of free triiodothyronine （FT3）： the group 1 （FT3≤4.28 pmol/L, n=335）, the group 2 （FT3〉4.28-〈4.79 pmol/L, n=310）, and the group 3 （FT3 4.79-6.30 pmol/L, n=337）. ResultsAfter a follow-up period of （53.8±14.1） months, 39 patients （4.0%） either suffered death with all causes or received a cardiac transplantation （7.8%, 2.9% and 1.2% of the patients in the group 1, group 2 and group 3, respectively）. A multivariable Cox regression analysis revealed that FT3≤4.28 pmol/L was associated with a significantly higher risk of all-cause mortality or cardiac transplantation （HR 8.83, 95% CI 1.115- 69.905,P=0.039） in HCM patients. ConclusionsLow levels of FT3 is a risk factor of adverse events for patients with HCM, indicting a role of FT3 as a marker for assessing the risk of long-term adverse events in these patients.