甲状腺功能异常在急性ST段抬高型心肌梗死患者的临床特征及意义

Clinical characteristics and significance of thyroid dysfunction in patients with acute st-segment elevation myocardial infraction

目的采用倾向性评分匹配法探讨急性ST段抬高型心肌梗死(ST-segment elevation myocardial infraction,STEMI)合并甲状腺功能亢进(甲亢)和甲状腺功能减退(甲减)患者的临床特征及预后差别。方法收集经皮冠状动脉介入治疗的40例急性STEMI合并甲亢患者临床资料;以甲亢患者病例数为基准,采用倾向性评分匹配方法按照1∶1比例从同期收集的急性心肌梗死患者中筛选出的40例急性STEMI甲状腺功能正常患者作为对照组,40例合并甲减患者为甲减组。比较3组临床用药、住院时间和住院并发症等情况。结果术后3组左心室舒张早期二尖瓣口流速峰值(E峰)、左心室射血分数差异均有统计学意义(P<0.05)。3组住院β受体阻滞剂及利尿剂使用情况差异均有统计学意义(P<0.05)。与对照组比较,甲状腺功能异常患者住院时间明显延长(P<0.05),严重心律失常、心房颤动及心力衰竭发生率均明显升高(P<0.05)。与甲亢组比较,甲减组住院时间更长,严重心律失常和心房颤动发生率更高(P<0.05)。结论接受经皮冠状动脉介入治疗的急性STEMI合并甲功异常患者中,合并甲减患者一般较合并甲亢患者预后更差。

Objective To investigate the differences of prognosis and the clinical characteristics in patients with acute ST-segment elevation myocardial infarction(STEMI)and thyroid dysfunction after propensity score matching.Methods Forty patients with STEMI and hyperthyroidism after group percutaneous coronary intervention were recruited.By using the propensity score matching model and based on the patients with hyperthyroidism(1∶1),STEMI patients with hypothyroidism(n=40)and STEMI patients with normal thyroid function(n=40)during the same period were retrospectively collected.The clinical medication,length of hospital-stay,and complications were analyzed in the three groups.Results Significant differences were observed among three groups in E peak and left ventricular ejection fraction(P<0.05),and in receptor blockers and diuretics use(P<0.05).Compared with control group,the length of hospital-stay,the incidence of severe arrhythmia,atrial fibrillation,and heart failure in both hyperthyroidism and hypothyroidism group were significantly increased(P<0.05).Compared with hyperthyroidism group,hypothyroidism group had the longer length of hospital-stay and the higher incidence of severe arrhythmia,atrial fibrillation(P<0.05).Conclusion For patients with acute STEMI and thyroid dysfunction after percutaneous coronary intervention,patients with hypothyroidism generally have a worse prognosis than patients with hyperthyroidism.