老年低三碘甲状腺原氨酸综合征患者血清三碘甲状腺原氨酸水平与冠状动脉病变的相关性分析

摘要

Objective To investigate the coronary artery lesion in elderly patients with coronary heart disease combined with low three triiodothyronine (T3) syndrome,analyze the correlation between T3 serum hormone levels and the coronary artery disease.Methods A total of 986 cases with low T3 syndrome in elderly patients with coronary artery disease as group A (low T3 group),1 074 cases with normal free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimulating hormone (TSH)in elderly patients of coronary heart disease as group B (control group).The levels of FT3,FT4,TSH in two groups were determined,The level of coronary artery disease was evaluated by lesion count and Gensini score according to the results of coronary arteriongraphy,analysis.Results Group A had higher age than the group B (P＜0.05).The levels of total cholesterol and LDL-C were higher in group A than in group B(P＜0.05).Serum FT3 values,in group A was lower than groupB[(1.0±0.6)pmol/L vs (4.1± 0.5) pmol/L,P＜0.05)],serum FT4 and TSH were no significant different between the two groups.Group A's total gensini score was higher than group B [(43.5± 18.3) vs.(24.5 ± 10.1),P＜0.05)].As the characteristics of coronary artery lesion,3 vessel disease incidence was higher in the low T3 group than that of control group (P＜ 0.05).In the low T3 group,severe coronary artery stenosis (arbitrary 1 of 3 major vascular stenosis in excess of 75％) and complete occlusion (arbitrary 1 of 3 major vascular occlusion) were higher compared with group B (P＜0.05).Multivariate logistic regression analysis showed that age and low FT3 were related to number and degree of coronary artery lesions.Conclusions The lesion of coronary heart disease in the elderly patients with low T3 syndrome are mainly multivessel and two-vessel involving a wide range and higher severity.%目的 探讨合并低三碘甲状腺原氨酸(T3)综合征的老年冠心病患者冠状动脉病变特点,并分析血清T3激素水平与冠状动脉病变的相关性.方法 选取符合低T3综合征诊断的老年冠心病患者986例为低T3组,游离T3(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)均正常的老年冠心病患者1074例为对照组.测定两组FT3、FT4、TSH水平,根据冠状动脉造影结果以病变支数及Gensini积分评价冠状动脉病变程度,分析血清T3水平与冠状动脉病变的相关性. 结果 低T3组患者年龄比对照组高(P＜0.05),总胆固醇及低密度脂蛋白胆固醇水平比对照组高(均P＜0.05).血清FT3值,低T3组低于对照组[(1.0±0.6) pmol/L与(4.1±0.5)pmol/L,P＜0.05)],血清FT4、TSH两组差异无统计学意义.低T3组Gensini总积分高于对照组[(43.5±18.3)分与(24.5±10.1)分,P＜0.05)].两组冠状动脉病变特点比较,低T3组中3支血管病变发生率高于对照组(P＜0.05).低T3组中,冠状动脉重度狭窄(3支主要血管任意1支狭窄超过75％)和完全闭塞(3支主要血管任意1支完全闭塞)发生率高于对照组(均P＜0.05).多因素Logistic回归分析结果显示,年龄和低FT3与冠状动脉病变支数及病变程度相关.结论 低T3综合征的老年冠心病患者以多支病变和双支病变为主,冠状动脉病变累及范围广、程度重.