急性心肌梗死患者甲状腺激素水平与心肌损害、他汀药物负荷后血脂水平的相关性

Correlation between Thyroid Hormone Levels and Myocardial Damage and Plasma Lipid Levels after Statin Loading in Patients with Acute Myocardial Infarction

目的:探讨急性心肌梗死患者甲状腺激素水平与心肌损害、他汀药物负荷后血脂水平的相关性。方法:回顾性分析本院2016年1月-2018年1月收治的200例急性心肌梗死患者临床资料,收集患者一般资料,记录患者用药情况,分别将其纳入低剂量组、中剂量组、高剂量组,治疗前后检测甲状腺激素与心肌酶、hs-CRP及LVEF水平。结果:低、中、高剂量组患者年龄、性别、高血压比较,差异均无统计学意义(P>0.05)。高剂量组糖尿病、高血脂比例高于中剂量组、低剂量组(P<0.05)。治疗后患者hs-CRP、Log-CKMB、TSH低于治疗前(P<0.05),LVEF、Log-cTnI、FT3、FT4水平高于治疗前(P<0.05)。FT3与Log-CKMB、hs-CRP存在明显负相关,FT3与Log-cTnI、LVEF呈正相关性,FT4与TSH与上述指标无相关性。低、中、高剂量他汀治疗背景下,FT3与患者总胆固醇及LDL-C有相关性,中高剂量他汀类药物治疗的患者FT3降低,负荷后的总胆固醇与LDL-C升高。结论:甲状腺激素水平与急性心肌梗死患心肌损害有关,且不同剂量的他汀类药物影响患者血脂水平,糖尿病、心肌功能可作为预后影响因素,FT3则是MACE最强预测因子。

Objective:To investigate the correlation between thyroid hormone levels and myocardial damage and plasma lipid levels after statin loading in patients with acute myocardial infarction.Method:Clinical data of 250 patients with acute myocardial infarction admitted to our hospital from January 2016 to January 2018 were retrospectively analyzed.Patients were divided into low-dose,middle-dose and high-dose group according to the medication.Then the levels of thyroid hormone and myocardial enzymes,hs-CRP and LVEF were recorded.Result:There were no significant differences in age,gender and hypertension between the low,middle and high dose groups(P>0.05).The proportion of diabetes and hyperlipidemia in the high dose group was higher than that in the middle dose group and the low dose group(P<0.05).After treatment,the levels of hs-CRP,LogCKMB,and TSH were decreased(P<0.05),the levels of LVEF,Log-cTnI,FT3,and FT4 levels were increased(P<0.05).FT3 was negatively correlated with Log-CKMB and hs-CRP.FT3 was positively correlated with Log-cTnI and LVEF.FT4 and TSH showed no correlation with the above indicators.FT3 was associated with total cholesterol and low-density lipoprotein cholesterol under the statin therapy in low-dose,middle-dose and high-dose.FT3 was related to the plasma lipid levels.Among patients received the statin therapy in middle-dose and high-dose,total cholesterol and LDL cholesterol were increased when FT3 was decreased.Conclusion:Thyroid hormone levels are associated with myocardial damage in acute myocardial infarction,and different doses of statin drugs will affect the blood lipid levels,the diabetes and myocardial function can be used as prognostic factors,and FT3 is the strongest predictor of MACE.