亚临床甲状腺功能减退症对冠心病患者药物球囊介入治疗的影响

Influence of subclinical hypothyroidism on drug balloon interventional therapy in patients with coronary heart disease

目的:分析亚临床甲状腺功能减退症(SCH)对经皮冠状动脉(冠脉)药物球囊(DCB)介入治疗心血管事件的影响。方法:回顾性分析于2018年1月—2019年12月在阜外华中心血管病医院进行冠脉造影术确诊为冠心病并进行了DCB治疗的574例患者。按其促甲状腺激素(TSH)的含量分为两组,即482例甲状腺功能正常组(ET组)和92例SCH组。使用Kaplan-Meier生存分析,比较各组术后心血管事件(包括原位血管再次血运重建、新发血管血运重建、冠脉旁路移植、全因死亡)的差异,并使用多因素Cox回归分析术后心血管事件影响因素。结果:随访期间,ET组与SCH组原位血管再次血运重建事件(8.3%vs 20.7%,P=0.006)差异有统计学意义,生存分析(Log-rankχ~2=7.091,P=0.008)两组差异具有统计学意义。多因素Cox回归分析显示,TSH是原位血管再次血运重建危险因素(HR=2.391,95%CI:1.037~5.512,P=0.041)。结论:SCH患者经皮冠脉DCB植入术后预后较差,原位血管再次血运重建事件风险明显增加。

Objective:To analyze the effect of subclinical hypothyroidism(SCH)on cardiovascular events in percutaneous coronary drug balloon(DCB)interventional therapy.Methods:A retrospective analysis was performed on 574 patients diagnosed with coronary heart disease by coronary angiography and treated with drug balloon in Fuwahua Central Vascular Disease Hospital from January 2018 to December 2019.According to their thyroid stimulating hormone(TSH)content,they were divided into two groups,482 cases of normal thyroid function group(ET group)and 92 cases of SCH group.Kaplan-Meier survival analysis was used to compare the differences in postoperative cardiovascular events(including in situ revascularization,new vessel revascularization,coronary artery bypass grafting,all-cause death)between groups,and multivariate Cox regression analysis was used in postoperative cardiovascular events.Results:During the follow-up period,there was a statistically significant difference in in situ vascular revascularization events between the ET group and the SCH group(8.3%vs 20.7%,P=0.006).Survival analysis(Log-rankχ~2=7.091,P=0.008)showed the difference is statistically significant.Multivariate Cox regression analysis showed that TSH was a risk factor for in situ revascularization(HR=2.391,95%CI:1.037-5.512,P=0.041).Conclusion:Patients with SCH have a poor prognosis after percutaneous coronary DCB implantation.The risk of revascularization events in situ is significantly increased.