老年慢性心力衰竭患者氨基末端脑利钠肽前体、甲状腺激素水平变化及其对病情、预后的影响

Changes of Amino Terminal Pro-brain Natriuretic Peptide and Thyroid Hormone in Elderly Patients with Chronic Heart Failure

目的探讨老年慢性心力衰竭(chronic heart faiture,CHF)患者氨基末端脑利钠肽前体(NT-proBNP)、甲状腺激素水平变化及其对病情、预后的影响。方法选取2016年12月—2018年8月收治的116例老年CHF作为观察组,另选取同期行健康体检且身体健康的老年人92例作为对照组。比较两组NT-proBNP、甲状腺激素[三碘甲状腺原氨酸(T 3)、甲状腺素(T 4)、游离三碘甲状腺原氨酸(FT 3)、游离甲状腺素(FT 4)、促甲状腺激素(TSH)]水平。根据纽约心脏病协会(New York heart association,NYHA)心功能分级,将观察组分为Ⅱ级亚组、Ⅲ级亚组和Ⅳ级亚组,比较3组NT-proBNP、甲状腺激素水平;随访1年,根据有无心源性猝死或心力衰竭恶化再住院情况,将观察组分为预后良好亚组和预后不良亚组,比较两组NT-proBNP、甲状腺激素水平;分析老年CHF患者NT-proBNP与甲状腺激素的相关性。结果与对照组比较,观察组NT-proBNP水平升高,T 3、FT 3水平降低,差异有统计学意义(P<0.05或P<0.01);不同NYHA心功能分级的老年CHF患者NT-proBNP、T 3、FT 3水平总体比较差异有统计学意义(P<0.01);与预后不良亚组比较,预后良好亚组NT-proBNP水平下降,T 3、FT 3水平升高,差异有统计学意义(P<0.05或P<0.01)。Pearson相关性分析显示,NT-proBNP水平与T 3、FT 3水平呈负相关,与T 4、FT 4、TSH水平无相关性。结论老年CHF患者NT-proBNP水平升高,T 3、FT 3水平降低,且随着NYHA心功能分级的加重,NT-proBNP水平越高,T 3、FT 3水平越低,临床可将NT-proBNP、T 3、FT 3作为判断老年CHF患者病情严重程度及预后的指标。

Objective To investigate the changes of Amino-terminal pro-brain natriuretic peptide(NT-proBNP)and thyroid hormone in elderly patients with chronic heart failure(CHF)and their effect on the severity and prognosis.Methods A total of 116 elderly patients with CHF admitted to our hospital from December 2016 to August 2018 were selected as the CHF group,and 92 healthy elderly patients who underwent physical examination during the same period were selected as the control group.The levels of NT-proBNP and thyroid hormone[triiodothyronine(T3),thyroxine(T4),free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone(TSH)]were compared between the two groups.According to cardiac function classification by the New York Heart Association(NYHA),the observation group was divided into grade II subgroup,grade III subgroup and grade IV subgroup,and the levels of NT-proBNP and thyroid hormone levels in the three subgroups were compared.The observation group was divided into good prognosis subgroup and poor prognosis subgroup according to presence or absence of sudden cardiac death or rehospitalization due to deterioration of heart failure at 1-year follow-up.NT-proBNP and thyroid hormone levels were compared in the two subgroups.The correlation between NT-proBNP and thyroid hormone in elderly patients with CHF was analyzed.Results Compared with the control group,the level of NT-proBNP in the observation group was increased,while the levels of T3 and FT3 were decreased(P<0.05 or P<0.01).The level of NT-proBNP,T3 and FT3 in elderly CHF patients with different cardiac function grades by NYHA was statistically significant(P<0.01).Compared with the poor prognosis subgroup,the overall NT proBNP level in the good prognosis subgroup was decreased,whereas the T3 and FT3 levels were increased(P<0.05 or P<0.01).Pearson correlation analysis showed that NT-proBNP level was negatively correlated with T3 and FT3 levels,but not correlated with T4,FT4,and TSH levels.Conclusion In elderly patients with CHF,the level of plasma NT-proBNP was increased,while the level of T3 and FT3 was decreased.The aggravation of the patient's cardiac function grades by NYHA leads to a higher level of plasma NT-proBNP and a lower level of T3 and FT3.Therefore,Nt-proBNP,T3 and FT3 can be used as an effective indexes to evaluate the severity and prognosis of elderly patients with CHF.