亚临床甲状腺功能减退与急性冠状动脉综合征患者预后的关系

Relationship between subclinical hypothyroidism and prognosis of patients with acute coronary syndrome

目的探讨亚临床甲状腺功能减退与急性冠状动脉综合征(ACS)患者预后的关系。方法本研究为回顾性队列研究。选择2017年1月至2018年12月在我院心内科住院的ACS患者297例,根据是否合并亚临床甲减分为亚临床甲减组(113例)与甲功正常组(184例),比较两组一般临床资料、心功能、冠状动脉病变的情况,并对所有出院患者进行平均426 d的随访,记录主要不良心血管事件(MACE,包括复发心绞痛、非致死性卒中、心力衰竭、再次血运重建、心原性死亡)的发生情况;行logistic回归及ROC曲线评估促甲状腺激素(TSH)对ACS患者MACE事件的预测价值。结果与甲功正常组比较,亚临床甲减组患者的年龄更大,女性的比例更高,游离甲状腺素的水平整体偏低,差异均有统计学意义(均为P<0.05),两组基线心功能及冠状动脉病变情况差异无统计学意义(均为P>0.05)。与甲功正常组比较,亚临床甲减组的总体MACE事件及心力衰竭的发生率高于甲功正常组,差异有统计学意义(均为P<0.05)。二元logistic回归分析显示,亚临床甲减、空腹血糖及入院舒张压是ACS患者预后不良的独立危险因素(均为P<0.05)。ROC曲线显示,血清TSH对ACS患者发生MACE事件的预测价值最高,曲线下面积为0.628(95%CI:0.552~0.704)。结论亚临床甲减可增加ACS患者的预后风险,血清TSH水平可作为ACS患者预后不良的一项预测指标。

Objective To investigate the relationship between subclinical hypothyroidism and outcome of patients with acute coronary syndrome(ACS).Methods A total of 297 patients with ACS hospitalized in the Department of Cardiology of our hospital from January 2017 to December 2018 were selected.According to their serum thyroid stimulating hormone(TSH)and free thyroxine(FT4)levels,they were divided into subclinical hypothyroidism group(113 cases)and euthyroid group(184 cases).The differences of general clinical data,cardiac function,coronary artery lesions between the two groups were compared.All the patients were followed up for an average of 426 days.Incidence of major adverse cardiovascular events(MACE)including recurrent angina,non-fatal stroke,heart failure,revascularization and cardiac death was observed.Logistic regression and ROC curve were used to evaluate the predictive value of TSH for MACE in ACS patients.Results Compared with the euthyroid group,the subclinical hypothyroidism group had older patients,higher proportion of females and lower level of FT4,the differences were statistically significant(all P<0.05),and there were no statistical differences between the two groups of baseline cardiac function and the coronary artery lesions(all P>0.05).Compared with the euthyroid group,the incidence of MACE and heart failure was higher in subclinical hypothyroidism group(P<0.05).The binary logistic regression analysis showed that subclinical hypothyroidism,fasting plasma glucose level and admission diastolic blood pressure level were independent risk factors for poor outcome in ACS patients(all P<0.05).ROC curve showed that serum TSH level had the highest predictive value for MACE in ACS patients,and the area under the curve was 0.628(95%CI:0.552-0.704).Conclusions Subclinical hypothyroidism can increase the prognosis risk of ACS patients,and serum TSH level can be used as a predictor of poor outcome of ACS patients.