甲状腺激素水平与肥厚型梗阻性心肌病患者心房颤动的发生相关性

Association between thyroid dysfunction and incidence of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy

目的房颤是肥厚型梗阻性心肌病(HOCM)最常见的持续性心律失常,研究发现每年有2%～3.8%的HOCM患者新诊断为房颤,这增加了此类患者心力衰竭、卒中/栓塞及死亡的风险。本研究探讨了HOCM患者的甲状腺功能状态与其发生房颤的相关性。方法本研究人群共纳入756例,男性456例,女性300例。根据患者是否伴发房颤分为:HOCM合并房颤组(107例),单纯HOCM组(649例)。结果本研究人群中房颤的发生率为14.15%,HOCM合并房颤患者较单纯HOCM组患者年龄更大[(56.99±11.73)岁比(50.18±12.81)岁,P <0.001],血肌酐[(82.77±23.73)μmol/L比(76.56±20.05)μmol/L,P=0.005]、NT-proBNP[(2476.08±1808.93)fmol/mL比(1814.85±1712.95)fmol/mL,P=0.002]及FT4[(1.26±0.26)ng/dL比(1.18±0.23)ng/dL,P=0.002]水平更高(P <0.05),FT3[(2.88±0.59)pg/dL比(2.99±0.54)pg/dL,P=0.046]水平更低。根据患者血浆中TSH水平分成4组,即TSH<0.55、0.55～2.49、2.50～9.99和≥10.00mIU/L组,不同TSH水平组间性别、吸烟史、TC、LDL-C、TSH、FT3、FF4、左心室舒张末期前后径、左心室射血分数(LVEF)以及房颤发生率差异有统计学意义(P <0.05)。TSH在0.55～2.49 mlU/L时房颤发生率最低(10.20%),TSH>10.00 mIU/L时发生率最高(35.29%),而TSH在<0.55、2.50～9.99时房颤发生率分别为27.02%、19.43%,组间比较差异有统计学意义(P <0.001)。另外,与TSH 0.55～2.49mIU/L组(正常对照组)相比,TSH异常组总胆固醇平均水平更高(P=0.012),LDL-C水平更高(P=0.002),而NT-proBNP、肌酸激酶同工酶(CK-MB)、尿酸、LAEDD、LVEDD差异无统计学意义(P>0.05)。年龄(OR1.045,95%CI1.027～1.063,P <0.001),NT-proBNP(每100fmol/mL,OR1.017,95%CI1.006～1.029,P=0.003),血肌酐(OR1.013,95%CI 1.004～1.022,P=0.006),FT3(OR0.616,95%CI 0.392～0.968,P=0.035),FT4(OR3.336,95%CI1.483～7.503,P=0.004)。年龄是房颤发生的危险因素。以TSH 0.55～2.49mIU/L水平为基准,TSH 2.50～9.99 mIU/L(OR1.977,95%CI 1.115～3.506,P=0.02)、TSH>10.00mIU/L(OR4.301,95%CI1.059～17.476,P=0.04)发生房颤的风险呈上升趋势。结论 TSH升高是HOCM发生房颤的独立危险因素。

Objective To explore the correlation between incidence of atrial fibrillation(AF)and thyroid dysfunction in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods Thyroid function testing in 756 consecutive patients with HCM were examined at the National Center for Cardiovascular Diseases(China)from October 2009 to December 2013 and followed up through December 2016.Patients were divided into four groups according to the TSH levels:TSH<0.55 mIU/L(n =37),0.55～2.49 mIU/L(n =490),2.50～9.9 mIU/L(n =211)and >10.00 mIU/L(n =17).Results TotaI of 107 patients were diagnosed with AF(14.15%).Compare to HOCM patients without AF,HOCM patients with AF have older age(P <0.001),higher NT-proBNP(P =0.002),higher Cr(P =0.005),larger left atrial diameter(P =0.001),lower FT3(P =0.046),higher FT4(P =0.004).In the four groups according to the TSH levels:TSH<0.55 mIU/L,0.55-2.49 mIU/L,2.50-9.9 mIU/L and ≥10.00 mIU/L,the incidence of AF were 27.02%(10/37),10.20%(50/490),19.43%(41/211),and 35.29%(6/17),respectively.Both high and low TSH levels were associated with an increased incidence of AF.After adjustment for common risk factor(age,NTproBNP and so on),stepwise multiple logistic regression analysis revealed that TSH levels were significantly related with the incidence of AF.Compared to patients with TSH 0.55-2.49 mlU/L,the adjusted odds ratio of AF for TSH<0.55,2.50-9.99,≥10.00 mIU/L were 1.481(95%CI 0.485-4.518,P =0.490),1.977(95%CI 1.115-3.506,P =0.02),4.301(95%CI 1.059-17.476,P =0.041),respectively.Conclusion Our results suggested that thyroid dysfunction were associated with an increased risk of AF in patients with HOCM.