急性心肌梗死合并甲状腺功能减低患者的临床特征观察

Clinical characteristics of patients with acute myocardial infarction and hypothyroidism

目的分析急性心肌梗死(AMI)合并甲状腺功能减低患者的发病情况及临床特点,探讨甲状腺功能减低与AMI的关系。方法回顾性分析511例AMI患者的临床资料,依据甲状腺功能分为甲状腺功能减退组(甲减组,40例)、亚临床甲状腺功能减退组(亚甲减组,67例),低T3综合征组(低T3组,52例)和甲状腺功能正常组(对照组,352例)。比较4组的一般情况、生化检查指标、冠脉病变情况及心脏超声指标差异。多因素Logistic回归分析心肌梗死患者合并甲状腺功能减低的影响因素。结果相比对照组,甲减组和低T3组患者年龄偏大,高血压患病比例和Gensini评分均较高,但高密度脂蛋白胆固醇(HDL-C)水平偏低(P<0.05)。亚甲减组与对照组相比,表现为低密度脂蛋白胆固醇(LDL-C)升高,左房内径(LAD)增大,左室射血分数(LVEF)降低(P<0.05)。Logistic回归分析显示高龄(OR=1.038)、患有高血压(OR=1.992)和高水平的LDL-C(OR=1.649)是心肌梗死患者发生甲状腺功能减低的危险因素,而高水平的游离三碘甲腺原氨酸(FT3,OR=0.550)、HDL-C(OR=0.172)和LVEF(OR=0.953)可能是其保护因素。结论 AMI合并甲状腺功能减退症患者存在明显的血脂代谢异常,冠脉狭窄加重、心功能不全及低水平FT3则甲减情况越严重;在临床的早期,可以从患者的甲状腺功能,尤其是FT3水平,来预测心肌梗死的发生发展。

Objective To investigate the clinical characteristics of patients with acute myocardial infarction(AMI)combined with hypothyroidism,and to explore the correlation between thyroid function and AMI.Methods The clinical data of511patients with AMI combined with hypothyroidism were retrospectively analyzed.According to thyroid function,patients were divided into hypothyroidism group(n=40),subclinical hypothyroidism group(n=67),low T3syndrome group(n=52)and normal thyroid function group(the normal group,n=352).The general situation,biochemical indexes,coronary lesions and echocardiographic indexes were compared between the four groups.Multivariate Logistic regression analysis of the influencing factors of hypothyroidism were analysed in patients with myocardial infarction.Results Compared with the control group,patients showed higher age,increased proportion of hypertension,Gensini score and lower level of highdensity lipoprotein cholesterol(HDL-C)in the hypothyroidism group and the low T3group(P<0.05).Compared with the control group,the level of low-density lipoprotein cholesterol(LDL-C)was significantly elevated,left atrial diameter(LAD)increased,and left ventricular ejection fraction(LVEF)decreased in hypothyroidism group(P<0.05).Logistic regression analysis showed that advanced age(OR=1.038),hypertension(OR=1.992)and high level of LDL-C(OR=1.649)were the risk factors for the occurrence of hypothyroidism in patients with myocardial infarction,and the high level of HDL-C(OR=0.172),free triiodothyronine(FT3,OR=0.550)and LVEF(OR=0.953)may be protective factors.Conclusion Patients with AMI and hypothyroidism show dyslipidemia,increased coronary stenosis,cardiac insufficiency,and the lower level of FT3.In the early clinical stage,the development of myocardial infarction can be predicted from the thyroid function in patients,especially the level of FT3.