Obiective Tend to explore the correlation between thyroid function and the severity of coronary artery lesions in chinese coronary heart disease(CHD)patients. Methods A total of 558 patients who underwent coronary angiography at the cardiology department of Peking University First Hospital from January 2013 to June 2015 were enrolled in this retrospective study. All patients were divided into coronary heart disease group and non-coronary heart disease group. Thyroid hormone levels were tested in all patients before angiography,and clinical characteristics,lipid profiles and SYNTAX scores were also obtained. Results Of the 558 patients,409 were diagnosed of CHD(73.3％),and among them,5 patients were hyperthyroid/subclinical hyperthyroid(1.2％),13 patients were hypothyroid/subclinical hypothyroid(3.2％),14 patients had euthyroid sicknesssyndrome(ESS)(3.2％),377 patients were euthyroid(92.2％). Among the 149 non-CHD patients(26.7％),3 patients were subclinical hyperthyroid(2.0％),8 patients were hypothyroid/subclinical hypothyroid(5.4％),2 patients were ESS(1.3％),172 patients were euthyroid(91.3％). The proportion of patients with ESS in the CHD group was significantly higher than that of the non-CHD group (3.4％ vs. 1.3％,P=0.018). Except for the patients with ESS,FT3 level was significantly lower the in CHD group than that in the non-CHD group[(4.52±0.57)pmol/L vs.(4.65±0.63)pmol/L,P=0.015]. There were no significant differences in FT4,T3,T4 levels between the two groups(P>0.05). In the CHD group,there was an association between the SYNTAX score groups and free triiodothyronine(FT3)levels(F=6.260,P=0.002). A significant correlation was also observed between the FT3 level and the number of coronary artery lesions(F=5.691, P=0.004). There was no correlation between the SYNTAX score groups or number of coronary artery lesions and thyroid hormone levels,respectively. There were no correlations between lipid profiles and thyroid function. Patients were further divided into three subgroups according to their serum TSH levels. The prevalence of CHD is significantly higher in the subgroup with elevated TSH(85.7％)than in the subgroup with normal TSH(68.6％, P=0.022). Conclusions FT3 level is weakly associated with the severity of CHD. Higher TSH level may be a risk factor of CHD.%目的 探讨甲状腺功能与冠心病及其严重程度的关系.方法 回顾分析2013年1月至2015年6月在北京大学第一医院因疑诊冠心病进行冠状动脉造影检查并行甲状腺功能检测的患者558例,根据冠状动脉造影结果,分为冠心病组和非冠心病组,分析两组患者甲状腺功能状态,比较甲状腺激素水平和冠心病的关系;采集冠心病组患者的Syntax积分,分析其与甲状腺激素水平的相关性;依据促甲状腺素(TSH)水平进一步分层为升高组、正常组、减低组,分析其与冠心病病变的关系.结果 本研究共纳入患者558例,男348例,女210例,平均年龄(62.7±10.9)岁.冠心病组409例(73.3％),平均年龄(63.3±11.0)岁.非冠心病组149例(26.7％),平均年龄(61.2±10.7)岁.两组患者的性别、年龄比较,差异无统计学意义.冠心病组低T3综合征患者比例明显高于非冠心病组(3.4％ 比1.3％,P=0.018),其他甲状腺功能异常状态两组比较,差异均无统计学意义(均P>0.05).在非低T3综合征患者中分析,冠心病组游离三碘甲状腺原氨酸(FT3)水平低于非冠心病组[(4.52±0.57)pmol/L比(4.65±0.63)pmol/L,P=0.015].两组患者游离四碘甲状腺原氨酸(FT4)、三碘甲状腺原氨酸(T3)、四碘甲状腺原氨酸(T4)、TSH水平比较,差异均无统计学意义(均P>0.05).非低T3综合征的冠心病,395例患者中根据Syntax积分,低分组264例,中分组59例,高分组72例.FT3水平三组患者比较差异有统计学意义(F=6.260,P=0.002)而TT3、TT4、FT4、TSH水平,三组患者比较差异均无统计学意义.根据冠状动脉病变支数分组,单支病变组160例,双支病变组111例,三支病变组124例,FT3水平三组患者比较差异有统计学意义(F=5.691,P=0.004),TT3、TT4、FT4、TSH水平,三组患者比较差异均无统计学意义.所有患者均进行了TG、TCHO、HDL-C、LDL-C检测,经检验,所有患者的FT3、FT4、TT3、TT4、TSH水平与血脂各组份均未见显著相关性.按正常值范围将FT3、FT4、TT3、TT4、TSH分别分为升高组、正常组、减低组,与冠心病诊断进行卡方检验,FT3、FT4、TT3、TT4差异均无统计学意义,TSH分层与冠心病诊断存在统计学意义(P=0.040).进一步两两比较,TSH减低组与TSH正常组差异无统计学意义,高TSH组冠心病患者(85.7％)高于TSH正常组(68.6％),差异有统计学意义(P=0.022).结论 甲状腺功能在冠心病组和非冠心病组中差异较小,仅见FT3减低且与冠心病及其严重程度相关.TSH升高可能是影响冠心病发病的因素之一.
展开▼
