甲状腺功能减退及SDF-1α、sIL-2R水平对急性心肌梗死患者发生不良心血管事件的影响

Effect of hypothyroidism and SDF-1 α,sIL-2R levels on adverse cardiovascularevents in patients with acute myocardial infarction

目的 探讨甲状腺功能减退(以下简称甲减)及基质细胞衍生因子-1α(SDF-1α)、可溶性白细胞介素2受体(sIL-2R)对急性心肌梗死(AMI)患者发生不良心血管事件的影响。方法 选取2016年5月至2021年5月于该院就诊的200例AMI患者为研究对象,全部患者均行甲状腺功能、SDF-1α、sIL-2R、血脂检测及冠状动脉(简称冠脉)造影,按甲状腺功能检测结果将患者分为甲减组(出现甲减)与甲状腺功能正常组(甲状腺功能正常)。按冠脉造影结果将甲减组患者分为单支组(冠脉病变支数为1支)、双支组(冠脉病变支数为2支)与多支组(冠脉病变支数>2支)。全部患者均随访1年,按随访结果将患者分为发生组(发生不良心血管事件)与未发生组(未发生不良心血管事件)。分析甲减及SDF-1α、sIL-2R水平对AMI患者发生不良心血管事件的影响。结果 甲减组TSH、sIL-2R、LDL-C、TC、TG水平及Gensini总积分高于甲状腺功能正常组,FT4、FT3、SDF-1α、HDL-C水平低于甲状腺功能正常组,差异均有统计学意义(P<0.05)。甲减组患者中单支组TSH、sIL-2R水平及Gensini总积分低于双支组、多支组,FT4、FT3、SDF-1α、HDL-C水平高于双支组、多支组,差异均有统计学意义(P<0.05);双支组TSH、sIL-2R水平及Gensini总积分低于多支组,FT4、FT3、SDF-1α、HDL-C水平高于多支组,差异均有统计学意义(P<0.05)。不良心血管事件发生组冠脉病变数及TSH、sIL-2R水平高于未发生组,FT4、FT3、SDF-1α水平低于未发生组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,冠脉病变数≥2支、TSH≥5.12μU/mL、sIL-2R≥402.55 U/mL是AMI患者发生不良心血管事件的危险因素(P<0.05),FT4>0.39 pg/mL、FT3>1.87 pg/mL、SDF-1α>1 902.49 mg/L是AMI患者发生不良心血管事件的保护因素(P<0.05)。结论 甲减及SDF-1α、sIL-2R水平对AMI患者发生不良心血管事件有影响,TSH≥5.12μU/mL、sIL-2R≥402.55 U/mL是AMI患者发生不良心血管事件的危险因素,FT4>0.39 pg/mL、FT3>1.87 pg/mL、SDF-1α>1 902.49 mg/L是AMI患者发生不良心血管事件的保护因素。

Objective To investigate the effects of hypothyroidism and stromal cell derived factor-1α(SDF-1α),soluble interleukin-2 receptor(sIL-2R)on the adverse cardiovascular events occurrence in the patients with acute myocardial infarction(AMI).Methods Two hundreds cases of AMI treated in this hospital from May 2016 to May 2021 were selected as the study subjects and conducted the thyroid function,SDF-1α,sIL-2R and blood lipids detection and coronary angiogram.The patients were divided into the hypothyroidism group(hypothyroidism appearance)and normal thyroid function group according to the thyroid function detection results.The hypothyroidism group was sub divided into the single vessels group(1 coronary lesion vessels),double vessels group(2 coronary lesion vessels)and multi vessels group(coronary lesion vessels>2).All patients were followed up for 1 year,and the patients were divided into the occurrence group(adverse cardiovascular event occurrence)and the non-occurrence group(without adverse cardiovascular event occurrence)based on the results after follow-up.The effect of hypothyroidism and the levels of SDF-1αand sIL-2R on the adverse cardiovascular event occurrence in the patients with AMI was analyzed.Results The TSH,sIL-2R,LDL-C,TC,TG levels and Gensini total scores in the hypothyroidism group were higher than those in the normal thyroid function group,while levels FT4,FT3,SDF-1αand HDL-C were lower than those in the normal thyroid function group,and the differences were statistically significant(P<0.05).In the hypothyroidism group,the TSH,sIL-2R levels,and Gensini total scores in the single vessels group were lower than those in the double vessels group and multi vessels group,and FT4,FT3,SDF-1α,and HDL-C levels were higher than those of the double vessels group and the multi vessels group,and the differences were statistically significant(P<0.05).The TSH,sIL-2R levels,and Gensini total scores in the double vessels group were lower than those in the multi vessels group,and FT4,FT3,SDF-1α,and HDL-C levels were higher than those of the multi vessels group,and the differences were statistically significant(P<0.05).The number of coronary lesion vessels,TSH and sIL-2R levels in the occurrence group were higher than those in the non occurrence group(P<0.05),while the FT4,FT3 and SDF-1αlevels were lower than those in the non occurrence group(P<0.05).The multivariate Logistic regression analysis results showed that the number of coronary artery lesion vessels≥2 and TSH≥5.12μU/mL and sIL-2R≥402.55 U/mL were the risk factors for adverse cardiovascular event occurrence in the patients with AMI(P<0.05),FT4>0.39 pg/mL,FT3>1.87 pg/mL and SDF-1α>1902.49 mg/L were the protective factors for adverse cardiovascular event occurrence in the patients with AMI(P<0.05).Conclusion Hypothyroidism,SDF-1αand SIL-2R levels have impact on adverse cardiovascular event occurrence in the patients with AMI.TSH≥5.12μU/mL and sIL-2R≥402.55 U/mL are the risk factors for adverse cardiovascular event occurrence in AMI patients,FT4>0.39 pg/mL,FT3>1.87 pg/mL and SDF-1α>1902.49 mg/L are the protective factors for adverse cardiovascular event occurrence in the patients with AMI.