甲状腺功能与急性心肌梗死患者心肌损害的关系及对术后近期预后的影响

Relationship between Thyroid Function and Myocardial Damage in Patients with Acute Myocardial Infarction and Its Effect on Short-term Postoperative Prognosis

目的:探讨甲状腺功能与急性心肌梗死患者心肌损害的关系及对术后近期预后的影响。方法:选择2017年2月-2019年2月本院486例拟行经皮冠状动脉介入治疗(PCI)术的急性心肌梗死患者,根据术前甲状腺功能状态分为甲状腺功能正常组(n=371)、甲状腺功能减退组(n=83)和甲状腺功能亢进组(n=32)。比较术前三组促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)。分析TSH、FT3与cTnI、CK-MB的相关性。随访12个月,比较三组主要心脏不良事件(MACE)发生情况。结果:三组TSH、FT3、cTnI、CK-MB比较,差异均有统计学意义(P<0.05);甲状腺功能减退组TSH、cTnI、CK-MB水平均高于甲状腺功能正常组和甲状腺功能亢进组,FT3低于甲状腺功能正常组和甲状腺功能亢进组,差异均有统计学意义(P<0.05);甲状腺功能亢进组TSH低于甲状腺功能正常组、FT3、cTnI、CK-MB均高于甲状腺功能正常组,差异均有统计学意义(P<0.05)。急性心肌梗死患者术前血清TSH水平与cTnI、CK-MB水平均呈正相关(r=0.598、0.696,P<0.05),FT3水平与cTnI、CK-MB水平均呈负相关(r=-0.512、-0.492,P<0.05)。随访12个月,三组MACE发生率比较,差异有统计学意义(P<0.05)。甲状腺功能减退组的MACE发生率高于甲状腺功能正常组和甲状腺功能亢进组(P<0.05)。结论:甲状腺功能减退可增重急性心肌梗死患者的心肌损害程度,甲状腺功能对急性心肌梗死患者术后近期预后具有一定预测价值。

Objective:To investigate the relationship between thyroid function and myocardial damage in patients with acute myocardial infarction and its effect on the short-term postoperative prognosis after.Method:A total of 486 patients with acute myocardial infarction who planned to receive percutaneous coronary intervention(PCI)in our hospital from February 2017 to February 2019 were selected.They were divided into normal thyroid group(n=371),hypothyroidism group(n=83)and hyperthyroidism group(n=32)according to their preoperative thyroid function status.Thyroid stimulating hormone(TSH),free triiodothyronine(FT3),troponin(cTnI)and creatine kinase isoenzyme(CK-MB)were compared among the three groups before surgery.The correlation between TSH,FT3 and cTnI,CK-MB was analyzed.The incidence of major adverse cardiac events(MACE)in three groups were compared after 12 months of follow-up.Result:There were statistically significant differences in TSH,FT3,cTnI and CK-MB among three groups(P<0.05).The levels of TSH,cTnI and CK-MB in hypothyroidism group were higher than those in normal thyroid function group and hyperthyroidism group,and FT3 was lower than those in normal thyroid function group and hyperthyroidism group,with statistical significance(P<0.05).TSH in the hyperthyroidism group was lower than that in the normal thyroid function group,and FT3,cTnI and CK-MB were higher than those in the normal thyroid function group,with statistical significance(P<0.05).There was a positive correlation between serum TSH level and cTnI,CK-MB level before acute myocardial infarction(r=0.598,0.696,P<0.05),and there was a negative correlation between FT3 level and cTnI and CK-MB level(r=-0.512,-0.492,P<0.05).After 12 months of follow-up,there was statistically significant difference in the incidence of MACE among the three groups(P<0.05).The incidence of MACE in hypothyroidism group was higher than those in normal thyroid function group and hyperthyroidism group(P<0.05).Conclusion:Hypothyroidism can increase the degree of myocardial damage in patients with acute myocardial infarction.Thyroid function has a certain predictive value for the short-term prognosis of patients with acute myocardial infarction.