重度慢性心力衰竭患者游离三碘甲状腺原氨酸水平与预后的相关性

Relationship between serum free triiodothyronine and prognosis in patients with severe chronic heart failure

目的分析游离三碘甲状腺原氨酸(FT3)水平与重度慢性心力衰竭(CHF)患者预后的相关性。方法收集2014年4月至2015年1月于该院住院、纽约心脏病协会(NYHA)分级心功能Ⅳ级的CHF患者190例作为研究对象,并随访6个月,主要终点事件为全因死亡,次要终点事件为因心力衰竭加重住院或因心力衰竭死亡。分析入院FT3水平与CHF患者6个月预后的相关性。结果根据患者入院时FT3三分位水平将患者分为FT3<3.45pmol/L(63例)、3.45~4.71pmol/L(64例)、>4.71pmol/L(63例)3组。FT3 3.45~4.71pmol/L组糖尿病患病率、N末端脑钠尿肽前体(NT-proBNP)水平明显低于FT3<3.45pmol/L组和FT3>4.71pmol/L组。多因素COX回归分析显示,FT3 3.45~4.71pmol/L(HR=0.475,95%CI:1.181~4.631,P=0.019)是全因死亡的独立保护因素,NT-proBNP(HR=1.516,95%CI:1.103~5.443,P<0.01)和糖尿病(HR=2.116,95%CI:1.218~5.652,P=0.021)是全因死亡的独立危险因素;FT3 3.45~4.71pmol/L(HR=0.567,95%CI:0.198~0.896,P=0.023)是心力衰竭加重住院或因心力衰竭死亡的独立保护因素,NTproBNP(HR=1.643,95%CI:1.132~5.467,P<0.01)和糖尿病(HR=2.253,95%CI:1.198~5.451,P=0.031)是心力衰竭加重住院或因心力衰竭死亡的独立危险因素。结论 FT3 3.45~4.71pmol/L的重度CHF患者全因死亡风险最低,同时该水平FT3也是因心力衰竭加重住院或因心力衰竭死亡的独立保护因素。

Objective To investigate the association between serum free Triiodothyronine （FT3） and prog-nosis in patients with severe chronic heart failure （CHF） .Methods A total of 190 cases of CHF admitted in the hospital from April 2014 to January 2015 ,who were diagnosed as cardiac function IV by New York heart disease association （NYHA） ,were enrolled in the study .Follow-up was carried out for 6 months ,the primary endpoint was all-cause death ,and the secondary endpoint was hospitalization or death due to heart failure .The correlation between FT3 level at admission and prognosis in 6 months of CHF patients was analyzed .Results Patients were divided into 3 groups：FT3〈3 .45 pmol/L （63 cases） ,3 .45 -4 .71 pmol/L （64 cases） and 〉4 .71 pmol/L （63 cases） according to the FT3 three percentile level at admission .The incidence of diabetes and the level of N terminal pro brain natriuretic peptide （NT-proBNP） in FT33 .45 -4 .71 pmol/L group were significantly lower than those in FT 3 4 .71 pmol/L group .Multiple factor COX regression analysis showed that FT 33 .45 -4 .71 pmol/L group （HR=0 .475 ,95％ CI：1 .181-4 .631 , P=0 .019） was an independent protective factor for all-cause of death .NT-proBNP （HR= 1 .516 ,95％ CI：1 .103-5 .443 ,P〈0 .01） and diabetes （HR=2 .116 ,95％ CI：1 .218-5 .652 ,P=0 .021） were independent risk factors for all-cause of death ;33 .45 -4 .71 pmol/L group （HR= 0 .567 ,95％ CI：0 .198 -0 .896 ,P= 0 .023） was an independent protective factors for hospitalization due to aggravated heart failure or death due to heart failure .NT-proBNP （HR= 1 .643 ,95％ CI：1 .132 -5 .467 ,P〈 0 .01） and diabetes （HR= 2 .253 ,95％ CI：1 .198-5 .451 ,P=0 .031） were independent risk factors for hospitalization due to aggravated heart failure or death due to heart failure .Conclusion Patients with severe CHF （FT33 .45-4 .71 pmol/L） have the lowest risk of all-cause death ,and the level of FT3 is also an independent protective factor for exacerbation of heart failure or death for heart failure .