干燥综合征合并亚临床甲状腺功能减退患者心脏功能的研究

Cardiac function of patients with Sjögren syndrome and subclinical hypothyroidism

目的明确干燥综合征(SS)合并亚临床甲状腺功能减退(SCH)患者心功能改变情况并分析其影响因素。方法回顾性分析中国医科大学附属第一医院风湿免疫科于2017年2月至2019年3月收治入院的186例确诊SS的患者。收集患者甲状腺功能、血脂、心脏超声测量指标[包括左心房内径(LA)、二尖瓣反流峰值、射血分数等]相关数据。根据患者甲状腺功能水平将纳入研究的患者分为甲功正常组(156例)和SCH组(30例);根据促甲状腺激素(TSH)水平又将SS合并SCH患者分为TSH<10 mU/L组(22例)及TSH≥10 mU/L组(8例)。对比分析各组间指标的差异,分析SS合并SCH患者甲状腺功能、血脂、心功能等临床指标的变化及其相关性并建立回归模型。结果对比甲功正常组与SCH组,两组间性别、年龄、血脂未见明显差异(P>0.05);SCH组相较甲功正常组,LA(P=0.044)及E峰(P=0.018)显著增高。合并SCH患者中,TSH≥10 mU/L组较TSH<10 mU/L组年龄(P=0.002)、低密度脂蛋白胆固醇(LDLc)(P=0.001)、总胆固醇(P=0.001)显著升高;对比心功能结果,TSH≥10 mU/L组LA显著增大(P=0.000),E峰降低(P=0.017),A峰升高(P=0.042),E/A比值显著降低(P=0.000)。Logistic回归分析显示甲状腺过氧化物酶抗体(TPOAb)、TSH、三酰甘油(TG)和游离甲状腺素(FT4)为SCH组患者舒张功能降低的影响因素(P<0.05),其中TPOAb(OR 1.89)、TSH(OR 1.00)、TG(OR 9.13)是危险因素(P<0.05),FT4为保护因素(OR 0.50)。结论SS合并SCH患者表现左心功能异常,其中TSH≥10 mU/L患者更容易出现血脂异常及左心舒张功能受限。TPOAb、TSH、TG、FT4与患者左心舒张功能异常相关。

Objective To make clear the changes in cardiac function of patients with Sjögren syndrome(SS)and subclinical hypothyroidism(SCH)and to analyze the influencing factors.Methods A retrospective analysis was performed in 186 patients with SS combined with SCH,who were admitted to the Department of Rheumatology and Immunology of the First Hospital of China Medical University from February 2017 to March 2019.Data related to thyroid function,serum lipid and echocardiographic indexes were collected,including left atrial diameter(LA),peak of mitral regurgitation,and ejection fraction,etc.According to the thyroid function level,patients were divided into the normal thyroid function group(156 cases)and the SCH group(30 cases);according to the thyroid stimulating hormone(TSH)level,SS patients combined with SCH were divided into TSH<10 mU/L group(22 cases)and TSH≥10 mU/L group(8 cases).Differences in the indexes were compared among the groups.The changes and correlations of clinical indicators such as thyroid function,blood lipids,and heart function in patients with SS and SCH were analyze,and a regression model was established.Results There were no obvious differences in gender,age or serum lipid between the normal group and the SCH group(P>0.05).Compared with the normal group,LA(P=0.044)and E peak(P=0.018)in the SCH group were significantly higher.Age(P=0.002),LDL-c(P=0.001)and TC(P=0.001)in TSH≥10 mU/L group were significantly higher than those in TSH<10 mU/L group.Comparing the cardiac function results,in TSH≥10 mU/L group,LA(P=0.000)and A peak(P=0.042)increased significantly,while E peak(P=0.017)and E/A ratio(P=0.000)decreased.Logistic regression showed that TPOAb,TSH,TG and FT4 were the influencing factors of reduced diastolic function in SCH group(P<0.05).TPOAb(OR 1.89),TSH(OR 1.00)and TG(OR 9.13)were risk factors(P<0.05),while FT4 was the protective factor(OR 0.50).Conclusion The patients with SS combined with SCH show abnormal left heart function,and those with TSH≥10 mU/L are more prone to dyslipidemia and limited left heart diastolic function.TPOAb,TSH,TG and FT4 are associated with abnormal left ventricular diastolic function in patients.