131Ⅰ治疗的甲状腺功能亢进症患者心房颤动相关性分析

Risk factors of atrial fibrillation in hyperthyroidism patients

目的分析131Ⅰ治疗的甲状腺功能亢进症(甲亢)患者发生心房颤动(房颤)的相关因素。方法回顾性分析2016年1月至2018年5月天津医科大学总医院核医学科行131I治疗的557例甲亢患者的临床资料。其中合并房颤者50例(房颤组)、未合并房颤者507例(无房颤组),采用倾向性评分匹配(PSM)法对两组数据进行随机配对,采用单因素和多因素的二元logistic回归方法分析甲亢患者发生房颤的独立相关因素。结果131I治疗前房颤组患者的年龄[(59.1±10.6)比(41.9±13.7)岁,t=6.75,P<0.01]、男性比例[42.0%(21/50)比19.7%(100/507),χ^2=14.11,P<0.01]、血清谷氨酰转肽酶(GGT)[72.1(38.0,97.0)比42.2(17.0,48.8)U/L,Z=4.97,P<0.01]、总胆红素[(21.3±8.8)比(13.8±7.7)μmol/L,t=5.26,P<0.01]、直接胆红素(DBIL)[12.6(7.9,17.4)比5.5(4.1,7.9)μmol/L,Z=6.62,P<0.01]、血清肌酐(Scr)[51.5(46.0,64.3)比42.0(35.0,51.0)μmol/L,Z=4.62,P<0.01]、血尿酸[(360.6±90.3)比(313.4±80.3)μmol/L,t=3.76,P<0.01]及ALT[28.0(19.3,41.8)比21.0(15.3,28.8)U/L,Z=3.46,P=0.01]水平均高于无房颤组,甲亢病程[66.0(6.8,120.0)比12.0(3.0,72.0)个月,Z=2.83,P=0.02]长于无房颤组,血小板计数[(188.5±60.8)×10^9/L比(241.0±65.1)×10^9/L,t=4.52,P<0.01]水平均低于无房颤组;既往合并冠心病[8例(16.0%)比13例(2.6%)]、高血压[15例(30.0%)比47例(9.3%)]等病史的甲亢患者发生房颤的概率更高(χ^2值为23.94和10.21,均P<0.01);但131I治疗前甲状腺激素、甲状腺抗体水平两组间差异无统计学意义。PSM随机配对后单因素logistic回归分析显示房颤与患者增龄、甲亢病程及Scr、血尿酸、总胆红素、DBIL、GGT及血小板计数等水平均有一定相关性[OR值(95%CI):1.14(1.09~1.20),P<0.01;OR值(95%CI):1.01(1.00~1.01),P=0.01;OR值(95%CI):1.06(1.02~1.09),P<0.01;OR值(95%CI):1.01(1.01~1.02),P<0.01;OR值(95%CI):1.15(1.07~1.22),P<0.01;OR值(95%CI):1.42(1.20~1.68),P<0.01;OR值(95%CI):1.04(1.02~1.05),P<0.01;OR值(95%CI):0.99(0.98~0.99),P<0.01];多因素logistic回归分析显示,患者增龄及血尿酸、DBIL、GGT水平与甲亢患者发生房颤为独立因素相关因素[OR值(95%CI):1.23(1.09~1.38),P<0.01;OR值(95%CI):1.01(1.00~1.20),P=0.05;OR值(95%CI):1.65(1.01~2.72),P=0.05;OR值(95%CI):1.04(1.01~1.08),P=0.01]。结论增龄及血尿酸、DBIL、GGT水平是甲亢患者发生房颤独立相关因素。

Objective To investigate the risk factors of atrial fibrillation(AF)in hyperthyroidism patients.Methods The clinical data of 557 patients with hyperthyroidism receiving 131I treatment from January 2015 to May 2018 were enrolled in the study.There were 50 cases with AF and 507 patients without AF before the treatment.Univariate and multivariate logistic regression were applied to analyze the risk factors of AF in hyperthyroidism patients.Results Compared to non-AF patients,AF patients had older age[(59.1±10.6)vs.(41.9±13.7)years,t=6.75,P<0.01],more males[42.0%(21/50]vs.19.7%(100/507),χ^2=14.11,P<0.01],longer duration of hyperthyroidism[66.0(6.8,120.0)vs.12.0(3.0,72.0)months,Z=2.83,P=0.02],higher prevalence of coronary artery disease[16.0%(8/50)vs.2.6%(13/507)]and hypertension[30.0%(15/50)vs.9.3%(47/507)],higher serum creatinine(SCr)[51.5(46.0,64.3)vs.42.0(35.0,51.0)μmol/L,Z=4.62,P<0.01],serum uric acid(SUA)[(360.6±90.3)vs.(313.4±80.3)μmol/L,t=3.76,P<0.01]and gamma-glutamy transpeptidase(GGT)[72.1(38.0,97.0)vs.42.2(17.0,48.8)U/L,Z=4.97,P<0.01]and total bilirubin(TBIL)(21.3±8.8)vs.(13.8±7.7)U/L,t=5.26,P<0.01],direct bilirubin(DBIL)[12.6(7.9,17.4)vs.5.5(4.1,7.9)μmol/L,Z=6.62,P=0.00)]and lower blood platelet(PLT)[(188.5±60.8)×10^9/L vs.(241.0±65.1)×10^9/L,t=4.52,P<0.01].And there were no significant differences in thyroid hormone level and thyroid autoimmune antibody levels.Univariate and multivariate analysis showed that the age(OR=1.23,95%CI:1.09-1.38,P<0.01),SUA(OR=1.01,95%CI:1.00-1.20,P=0.05),DBIL(OR=1.65,95%CI:1.01-2.72,P=0.05),GGT(OR=1.04,95%CI:1.01-1.08,P=0.01)were risk factors for AF in patients with hyperthyroidism.Conclusion Older age,abnormal serum SUA,DBIL and GGT are risk factors for atrial fibrillation in patients with hyperthyroidism,to timely control hyperthyroid and to give symptomatic treatment for those patients are necessary.