左旋甲状腺激素片在急性冠脉综合征合并亚临床甲状腺功能减退中应用临床研究

Clinical effect of levothyroxine tablets in treatment of patients with acute coronary syndrome complicated with subclinical hypothyroidism

目的探讨急性冠脉综合征合并亚临床甲状腺功能减退患者服用左旋甲状腺激素片的临床疗效。方法选取自2013年1月至2015年2月沈阳军区总医院心血管内科收治的357例亚临床甲状腺功能减退的急性冠脉综合征患者为研究对象。其中,123例未遵医嘱用药为A组,234例严格遵医嘱服用左旋甲状腺激素片做甲状腺替代治疗为B组,对患者进行1年的电话随访并建议患者出院后9~12个月来院复查冠脉造影,记录死亡、心肌梗死、出血及靶血管再次血运重建(TVR)等主要心血管不良事件(MACE)。结果两组患者进行随访并行冠脉造影发现,B组的MACE发生率为4.3%(10/234),低于A组的8.9%(11/123);B组的心肌梗死为0例,发生率低于A组的1.6%(2/123),差异均有统计学意义(P<0.05)。两组患者的病死率、TVR、出血学术研究会(BARC)等级比较,差异无统计学意义(P>0.05)。结论急性冠脉综合征合并亚临床甲状腺功能减退患者服用左旋甲状腺激素片做甲状腺替代治疗安全、有效,可减少心血管不良事件的发生。

Objective To investigate the clinical effect of levothyroxine tables for acute coronary syndrome（ ACS） complicated with subclinical hypothyroidism. Methods A retrospective study was performed on 357 cases of ACS patients with subclinical hypothyroidism who were admitted from January 2013 to February 2015. Among all the patients,123 cases who were not strictly prescribed for treatment were divided in Group A,the other 234 cases who were strictly prescribed for treatment of levothyroxine tables as thyroid replacement therapy were in Group B. One year follow-up was performed by telephone and patients were recommended to undergo coronary angiography 9-12 months after hospital discharge,the death,myocardial infarction,bleeding and target vessel again reascularization（ TVR） major adverse cardiovascular events（ MACE） were recorded. Results The results of follow-up and coronary angiography showed that,the incidence of MACE in Group B was 4. 3 %（ 10/234）,which was lower than 8. 9 %（ 11/123） in Group A; the incidence of myocardial infarction in Group B was 0,which was lower than 1. 6 %（ 2/123） in Group A（ P〈0. 05）. The mortality,TVR and BARC levels of the two groups had no statistically significant difference（ P〉0. 05）. Conclusion Levothyroxine tables as the thyroid replacement therapy in the treatment of acute coronary syndrome complicated with subclinical hypothyroidism is safe and effective,which may reduce the occurrence of cardiovascular events.