伴低三碘甲状腺原氨酸综合征急性心肌梗死患者临床特征及急性心肌梗死预后影响因素分析

摘要

Objective To investigate clinical characteristics and influencing factors on prognosis of patients with acute myocardial infarction associated by low triiodothyronine (T3) syndrome.Methods A total of 260 patients with acute myocardial infarction admitted during June 2012 and June 2014 were divided into euthyroidism group (n=150) and low T3 syndrome group (n=110) according to results of thyroid function and cardiac ultrasound examination.In two groups, clinical characteristics and incidence rate of cardiovascular events during follow-up were compared, and influencing factors on prognosis of patients with acute myocardial infarction were analyzed.Results Compared with those in low T3 syndrome group, in euthyroidism group, values of age, total cholesterol, low-density lipoprotein cholesterol, hospital stay and assisted continuous positive airway pressure rate were significantly lower;serum total triiodothyronine (TT3), free triiodothyronine (FT3) and left ventricular ejection fraction levels were significantly higher;incidence rates of recurrent myocardial infarction, new heart failure, sudden cardiac death and malignant arrhythmia during the follow-up were significantly lower (P<0.05).Univariate log-rank regression analysis showed that age, serum levels of FT3, left ventricular ejection fraction, history of hypertension and hyperlipidemia were influencing factors on prognosis of patients with acute myocardial infarction (P<0.05).Multivariate Cox proportional hazards model analysis showed that age (≥65 years old), serum FT3 level (<5.2 pmol / L) and score of left ventricular ejection fraction (<50%) were independent factors on prognosis for acute myocardial infarction (P<0.01).Conclusion Serum FT3 level has a certain relationship with prognosis of patients with acute myocardial infarction, and the incidence rate of cardiovascular events in acute myocardial infarction patients with serum FT3<5.2 pmol/L is increased, and then the prognosis is poor.%目的 探讨伴低三碘甲状腺原氨酸(T3)综合征急性心肌梗死患者临床特征及急性心肌梗死预后影响因素.方法 对2012年6月-2014年6月内蒙古医科大学附属医院收治的急性心肌梗死260例根据甲状腺功能及心脏超声检查结果分为甲状腺功能正常组(150例)和低T3综合征组(110例),比较两组临床特征及随访期间心血管事件发生情况,并对急性心肌梗死的预后影响因素进行分析.结果 甲状腺功能正常组年龄、总胆固醇、低密度脂蛋白胆固醇、住院时间及辅助持续气道正压通气率低于或短于低T3综合征组,血清总三碘甲状腺原氨酸(TT3)、游离三碘甲状腺原氨酸(FT3)及左心室射血分数高于低T3综合征组,随访期间再发心肌梗死、新发心力衰竭、心源性猝死及恶性心律失常发生率明显低于低T3综合征组,差异均具有统计学意义(P<0.05).单因素Log Rank回归分析显示,年龄、血清FT3水平、左心室射血分数、高血压病病史及高脂血症史为影响急性心肌梗死患者预后的因素(P<0.05).多因素Cox比例风险模型分析显示,年龄(≥65岁)、血清FT3水平(<5.2 pmol/L)和左心室射血分数(<50%)为影响急性心肌梗死患者预后的独立危险因素(P<0.01).结论 血清FT3水平与急性心肌梗死患者预后有一定相关性,血清FT3<5.2 pmol/L的急性心肌梗死患者心血管事件发生率增高,预后较差.