甲状腺功能正常的缺血性心肌病患者血清甲状腺激素浓度与血清NT-proBNP、同型半胱氨酸浓度的相关性

Correlations between Serum Concentrations of Thyroid Hormone with N-ter⁃minal Pro-B-type Natriuretic Peptide and Homocysteine in Ischemic Cardio⁃myopathy Patients with Normal Thyroid Function

目的 探讨甲状腺功能正常的缺血性心肌病(ischemic cardiomyopathy,ICM)患者血清甲状腺激素浓度与血清N末端B型脑钠肽前体(N-terminal pro-B-type natriuretic peptide,NT-proBNP)、同型半胱氨酸(homocysteine,Hcy)浓度的相关性。方法 选择界首市人民医院2021年8月至2022年8月收治的124例甲状腺功能正常的ICM患者作为研究对象。对所有患者根据美国纽约心脏协会(New York Heart Association,NYHA)心功能分级分为Ⅰ级组29例,Ⅱ级组27例,Ⅲ级组43例,Ⅳ级组25例;同时根据颈动脉内膜中层厚度(carotid intimamedia thickness,CIMT)分为CIMT增厚组41例,CIMT正常组83例。检测所有受试者的血清甲状腺激素[游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、促甲状腺激素(thyroid stimulating hormone,TSH)]浓度以及血清NT-proBNP、Hcy浓度;测定入选对象超声心动图指标,包括左心室射血分数(left ventricular ejection fraction,LVEF)、左心室舒张末期内径(left ventricular end diastolic diameter,LVEDD)、左心房内径(left atrial diameter,LAD),对入选对象行冠状动脉计算机断层扫描(computed tomography,CT)血管造影检查,并计算Gensini积分。分析血清甲状腺激素浓度与血清NT-proBNP、Hcy浓度等实验室指标的相关性。结果 采用Bonferroni法行多重比较发现,Ⅰ、Ⅱ、Ⅲ、Ⅳ级组患者和CIMT组患者之间血清TSH、NT-proBNP、Hcy浓度比较,差异均有统计学意义(P<0.0083)。Ⅲ级组患者血清FT3浓度显著低于Ⅰ级组,Ⅳ级组患者血清FT3浓度均显著低于Ⅰ级组和Ⅱ级组,差异有统计学意义(P<0.0083,P<0.0083)。Ⅲ级组和Ⅳ级组患者的LVEF均显著低于Ⅰ级组和Ⅱ级组,差异有统计学意义(P<0.0083)。Ⅲ级组和Ⅳ级组患者的LVEDD均显著高于Ⅰ级组,差异有统计学意义(P<0.0083)。Ⅱ级组、Ⅲ级组和Ⅳ级组Gensini积分均显著高于Ⅰ级组,差异有统计学意义(P<0.0083)。CIMT增厚组患者血清FT3、FT4浓度和LVEF均显著低于CIMT正常组,血清TSH、NT-proBNP、Hcy浓度和LVEDD、Gensini积分均显著高于CIMT正常组,差异有统计学意义(P<0.05)。血清FT3、FT4浓度与血清NT-proBNP、Hcy浓度和NYHA心功能分级、CIMT、Gensini积分均呈负相关(P<0.05),血清FT3、FT4浓度与LVEF均呈正相关(P<0.05),血清TSH浓度与LVEF呈负相关(P<0.05),血清TSH浓度与血清NT-proBNP、Hcy浓度和NYHA心功能分级、CIMT、LVEDD、LAD、Gensini积分均呈正相关(P<0.05)。结论 甲状腺功能正常的ICM患者的血清甲状腺激素浓度与血清NT-proBNP、Hcy浓度以及心功能分级、CIMT增厚与否、心脏结构与功能状态、冠状动脉病变程度密切相关;血清FT3、FT4浓度与血清NT-proBNP、Hcy浓度以及NYHA心功能分级、CIMT、Gensini积分均呈负相关,与LVEF均呈正相关;血清TSH浓度与血清NT-proBNP、Hcy浓度以及NYHA心功能分级、CIMT、LVEDD、LAD、Gensini积分均呈正相关,与LVEF呈负相关。

Objectives To explore the relationships between serum concentrations of thyroid hormone with N-terminal pro-B-type natriuretic peptide(NT-proBNP)and homocysteine(Hcy)in ischemic cardiomyopathy(ICM)patients with normal thyroid function.Methods A total of 124 ICM patients with normal thyroid function admitted to Jieshou People′s Hospital from August 2021 to August 2022 were selected as study objects.According to the New York Heart Association(NYHA),all the patients were divided into gradeⅠgroup(n=29),gradeⅡgroup(n=27),gradeⅢgroup(n=43)and gradeⅣgroup(n=25).Meanwhile,according to the carotid intima-media thickness(CIMT),the carotid artery featured 41 cases in CIMT thickened group and 83 cases in CIMT normal group.Serum concentrations of thyroid hor-mones[free triiodothyronine(FT3),free thyroxine(FT4)and thyroid stimulating hormone(thyrostimulating hormone,TSH)]and NT-proBNP,Hcy were detected in all the subjects.Echocardiographic parameters,including left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and left atrial diameter(LAD)were deter-mined.Coronary computed tomography(CT)angiography was performed on the selected subjects and Gensini scores were calculated.The correlations between serum concentrations of thyroid hormone with NT-proBNP,Hcy and other lab-oratory indexes were analyzed.Results Bonferroni method was used to perform multiple comparisons and it was found that the differences of serum concentrations of TSH,NT-proBNP and Hcy in gradeⅠ,Ⅱ,Ⅲ,Ⅳgroups and in CIMT groups were statistically significant(P<0.0083).The serum concentration of FT3 in gradeⅢgroup was significantly lower than that in gradeⅠgroup(P<0.0083),and the serum concentration of FT3 in gradeⅣgroup was significantly lower than that in gradeⅠgroup and gradeⅡgroup(P<0.0083).LVEF in gradeⅢgroup andⅣgroup was significantly lower than that in gradeⅠgroup andⅡgroup(P<0.0083).LVEDD in gradeⅢgroup andⅣgroup was significantly higher than that in gradeⅠgroup(P<0.0083).Gensini scores in gradeⅡ,ⅢandⅣgroups were significantly higher than that in gradeⅠgroup(P<0.0083).Serum concentrations of FT3,FT4 and LVEF in CIMT thickening group were significantly lower than those in CIMT normal group(P<0.05).Serum concentrations of TSH,NT-proBNP,Hcy and LVEDD and Gensini scores in CIMT thickening group were significantly higher than those in CIMT normal group(P<0.05).Serum concentrations of FT3 and FT4 were negatively correlated with serum concentrations of NT-proBNP and Hcy,NYHA cardiac function grade,CIMT and Gensini scores(P<0.05),while serum concentrations of FT3 and FT4 were positively correlated with LVEF(P<0.05).Serum concentrations of TSH was negatively correlated with LVEF(P<0.05),and serum concentrations of TSH was positively correlated with serum concentrations of NT-proBNP and Hcy,NYHA cardiac function grade,CIMT,LVEDD,LAD and Gensini scores(P<0.05).Conclusions Serum concentrations of thyroid hormone in ICM patients with normal thyroid function are closely related to serum concentrations of NT-proBNP and Hcy,cardiac function grade,CIMT thickening or not,cardiac structure and function status,and degree of coronary artery disease.Serum concentrations of FT3 and FT4 are negatively correlated with serum concentrations of NT-proBNP and Hcy,NYHA cardiac function grade,CIMT and Gensini scores,while serum concentrations of FT3 and FT4 are positively corre-lated with LVEF.Serum concentration of TSH is positively correlated with serum concentrations of NT-proBNP and Hcy,NYHA cardiac function grade,CIMT,LVEDD,LAD and Gensini scores,while serum concentration of TSH is negatively correlated with LVEF.