血清甲状腺激素水平与冠状动脉慢性完全闭塞病变患者侧支循环形成的相关性研究

Relationship between Serum Thyroid Hormone Level and Coronary Collateral Circulation in Patients with Coronary Artery Chronic Total Occlusion

目的探讨血清甲状腺激素(TH)水平与冠状动脉慢性完全闭塞病变(CTO)患者冠状动脉侧支循环(CCC)形成之间的关系。方法选取2015-09-01至2017-02-28在郑州大学第二附属医院心内科病房住院择期行冠状动脉造影术且至少1支主要冠状动脉CTO的冠心病患者86例,根据Cohen-Rentrop法评估CCC形成程度,分为不良组(23例)和良好组(63例)。分析患者一般资料、左心室射血分数(LVEF)、血常规、促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT_3)、游离甲状腺素(FT_4)、亚临床甲状腺功能减退症(SCH)情况。结果不良组糖尿病病史比例、高脂血症病史比例、吸烟比例、TSH水平、SCH比例均高于良好组,FT_3、FT_4水平均低于良好组(χ~2=6.192、6.031、6.720,Z=-2.410,χ~2=4.976,Z=-3.586、-2.802,P<0.05)。多因素Logistic回归分析模型1显示,糖尿病[OR=0.255,95%CI(0.066,0.981)]、吸烟[OR=0.136,95%CI(0.030,0.620)]、SCH[OR=0.048,95%CI(0.007,0.327)]是CCC形成不良的独立危险因素(P<0.05)。多因素Logistic回归分析模型2显示,糖尿病[OR=0.142,95%CI(0.027,0.761)]、吸烟[OR=0.128,95%CI(0.019,0.861)]、TSH[OR=1.955,95%CI(1.247,3.066)]、FT3[OR=0.170,95%CI(0.043,0.671)]是CCC形成不良的独立危险因素(P<0.05)。结论糖尿病、吸烟、SCH、TSH、FT3是冠状动脉CTO患者CCC形成不良的危险因素,为冠心病二级预防提供了新证据,从而更好地预防冠心病进展。

Objective To investigate the relationship between serum thyroid hormone（TH） level and formation of the coronary collateral circulation（CCC） in patients with coronary artery chronic total occlusion（CTO）.Methods Study subjects consisted of 86 patients who underwent coronary angiography and were confirmed to have at least one major coronary artery CTO in Department of Cardiovascular Medicine,the Second Affiliated Hospital of Zhengzhou University from 2015-09-01 to 2017-02-28.The patients were divided into the poor CCC group（n=23） and good CCC group（n=63） according to the Cohen-Rentrop method.General information,left ventricular ejection fraction（LVEF）,routine blood tests,thyroid stimulating hormone（TSH） level,free triiodothyronine（FT_3） level,free thyroxine（FT_4） level,and subclinical hypothyroidism（SCH） were analyzed.Results The poor CCC group had a higher proportion of patients with diabetes,hyperlipidemia and smoking than the good CCC group,TSH level and SCH were also higher in the poor CCC group than in the good CCC group,FT3 and FT4 levels in the poor CCC group were lower than those in the good CCC group（χ^2=6.192,χ^2=6.031,χ^2=6.720,Z=-2.410,χ^2=4.976,Z=-3.586,Z=-2.802,P〈0.05,respectively）.Multivariate Logistic regression model 1 showed that diabetes [OR=0.255,95%CI（0.066,0.981）],smoking [OR=0.136,95%CI（0.030,0.620）],and SCH [OR=0.048,95%CI（0.007,0.327）] were independent risk factors for poor CCC formation（P〈0.05）.Multivariate Logistic regression model 2 showed that diabetes [OR=0.142,95%CI（0.027,0.761）],smoking [OR=0.128,95%CI（0.019,0.861）],TSH [OR=1.955,95%CI（1.247,3.066）],and FT3 [OR=0.170,95%CI（0.043,0.671）] were independent risk factors for poor CCC formation（P〈0.05）.Conclusion Diabetes mellitus,smoking,SCH,TSH,and FT3 are risk factors for the formation of poor CCC in patients with coronary artery CTO.This study provides new evidence for the secondary prevention of coronary heart disease,and a potential strategy for preventing the progression of coronary heart disease.