甲状腺功能亢进合并心房颤动患者的临床特征及危险因素分析

Clinical features and risk factors analysis of patients with hyperthyroidism complicating atrial fibrillation

目的分析甲状腺功能亢进(简称甲亢)合并心房颤动患者的临床特征及预后差异。方法采用回顾性分析,收集2004-2022年成都医学院第二附属医院收治的1160例甲亢患者临床资料,以是否合并心房颤动为分组依据,将患者分为心房颤动组(n=581)和非心房颤动组(n=579),分析比较两组的甲状腺功能指标[游离型三碘甲状腺原氨酸(FT3)、游离型四碘甲状腺原氨酸(FT4)、促甲状腺激素(TSH)]和胆固醇、脑钠肽(BNP)、N末端脑钠肽前体(NT-proBNP)、甘油三酯(TG)水平,以及高血压史、糖尿病病史、吸烟史、左右心房(室)内径、左心室射血分数(LVEF)、美国纽约心脏病学会(NYHA)分级。对上述可能的危险因素进行多因素logistic回归分析。结果两组的年龄、FT3、TSH、左心房内径、LVEF、NYHA分级、BNP和NT-proBNP比较,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,左心房内径偏大、TSH偏低和BNP偏高是甲亢患者发生心房颤动的独立危险因素(P<0.05)。以上述3项指标预测甲亢患者发生心房颤动的受试者工作特征(ROC)曲线结果显示,左心房内径的曲线下面积明显高于TSH和BNP,差异有统计学意义(P<0.05)。结论甲亢患者左心房内径增大、TSH下降、BNP上升时,发生心房颤动的风险增大。

Objective To analyze the clinical characteristics and prognosis differences of the patients with hyperthyroidism complicating atrial fibrillation.Methods A retrospective analysis was adopted.The clinical data of 1160 patients with hyperthyroidism admitted and treated in the Second Affiliated Hospital of Chengdu Medical College during 2004-2022 were collected.The patients were divided into the atrial fibrillation group(n=581)and non-atrial fibrillation group(n=579)according to whether complicating atrial fibrillation.Then the levels of thyroid functional indicators[free triiodothyronine(FT3),free tetraiodothyronine(FT4),thyroid-stimulating hormone(TSH)],cholesterol,brain natriuretic peptide(BNP),N-terminal brain natriuretic peptide precursor(NT-proBNP)and triglyceride(TG)as well as the hypertension history,diabetic history,smoking history,inner diameter of left and right atrium(ventricle),ejection fraction and NYHA grade were analyzed and compared between the two groups.The multivariate logistic regression analysis was performed for the above possible risk factors.Results There were statistically significant differences in the age,FT3,TSH,left atrial diameter,LVEF,NYHA grade,BNP and NT-proBNP between the two groups(P<0.05).The multivariate logistic regression analysis results showed that left atrial inner diameter rather large,TSH rather low and BNP rather high were the independent risk factors for atrial fibrillation occurrence in the patients with hyperthyroidism.The results of receiver operating characteristic(ROS)curve of above 3 indicator in predicting the occurrence of atrial fibrillation occurrence in the patients with hyperthyroidism showed that the area under the curve of left atrial inner diameter was significantly higher than that of TSH and BNP,and the differences were statistically significant(P<0.05).Conclusion When the left atrial inner diameter in the patients with hyperthyroidism is enlarged,TSH is decreased and BNP is increased,the risk of atrial fibrillation occurrence is increased.