甲状腺功能异常对急性心肌梗死患者预后的影响

Prognostic Value of Thyroid Dysfunction in Patients With Acute Myocardial Infarction

目的:评估甲状腺功能异常对急性心肌梗死患者的心血管事件和死亡的预测价值。方法:纳入"冠心病医疗结果评价和临床转化研究(China PEACE)"-前瞻性急性心肌梗死数据库中,符合入组标准的2 569例急性心肌梗死患者,并根据甲状腺功能状态分为甲状腺功能正常组(n=2 036)、甲状腺功能减退组(n=431)和甲状腺功能亢进组(n=102)。随访12个月,主要研究终点为复合心血管不良事件,包括全因死亡、心肌梗死、再次血运重建和心力衰竭。结果:随访12个月期间,594例(23.1%)患者发生复合心血管不良事件,其中甲状腺功能正常组433例(21.3%),甲状腺功能减退组133例(30.9%),甲状腺功能亢进组28例(27.5%),三组间差异具有统计学意义(P<0.001)。校正传统危险因素后,相对于甲状腺功能正常组,甲状腺功能减退组患者复合心血管不良事件的风险显著升高(HR=1.337,95%CI:1.097～1. 630,P=0.004),甲状腺功能亢进组复合心血管不良事件风险无明显增加(HR=1.361,95CI:0.927～1. 998,P=0.116)。甲状腺功能减退与再次血管重建和心力衰竭显著相关(再次血管重建:HR=1.648,95%CI:1.047～2. 595,P=0.031;心力衰竭:HR=1.382, 95%CI:1.066～1. 792,P=0.014)。结论:甲状腺功能减退对急性心肌梗死患者的不良心血管事件有独立预测价值。

Objectives:The aim of the present study is to evaluate the predictive role of thyroid hormones in the prognosis of patients with acute myocardial infarction(AMI).Methods:Participants diagnosed with AMI from China PEACE prospective AMI study of 53 hospitals across 21 provinces in China were screened and followed up for 12 months.According to thyroid function profiles,the patients were divided into three groups,ie,euthyroid group,hypothyroidism group and hyperthyroidism group.The composite cardiovascular endpoint includes all-cause death,myocardial infarction,revascularization and heart failure.The risk of complex cardiovascular adverse events was compared among the three groups.Results:A total of 2 569 patients were included in this study,of which 594(23.1%)of the patients reached a composite cardiovascular endpoint.There were 433(21.3%)composite cardiovascular events in euthyroid group,133(30.9%)in hypothyroidism group and 28(27.5%)in hyperthyroidism group.After adjusting traditional risk factors,the risk of composite cardiovascular events in the hypothyroidism group was significantly higher than that of euthyroid group(HR=1.337,95%CI:1.097-1.630,P=0.004),and the risk of composite cardiovascular events in hyperthyroidism group was not significantly increased(HR=1.361,95 CI:0.927-1.998,P=0.116).Hypothyroidism was also significantly associated with the revascularization(HR=1.648,95%CI:1.047-2.595,P=0.031)and heart failure(HR=1.382,95%CI:1.066-1.792,P=0.014).Conclusions:Hypothyroidism is a strong predictor of cardiovascular events in patients with AMI and might be directly implicated in the poor prognosis of AMI.