甲状腺素在急性心肌梗死中变化特点及短期预后价值

Thyroid hormone changes in acute myocardial infarction and their value in short-term prognosis

摘要:

目的 探讨急性心肌梗死患者中甲状腺激素水平变化特点及原因，并分析其对短期死亡终点预后价值。方法 入选172例急性心肌梗死患者，并选取92例不稳定型心绞痛患者为对照组。所有入选患者均于入院后第2天测定游离三碘甲腺原氨酸（FT3）、血清游离甲状腺素（FT4）、促甲状腺激素（TSH）水平，测定血脂水平及高敏C反应蛋白水平。同时观测住院期间心血管死亡事件。结果 急性心肌梗死患者中，FT3、FT4、TSH水平分别为（2.33±0.47）ng/L，（12.5±2.4）ng/L 和（1.32±0.99）μU/L。不稳定型心绞痛患者中，FT3、FT4、TSH水平分别为（2.80±0.54）ng/L，（11.5±1.4）ng/L和（2.19±1.07）μU/L。急性心肌梗死患者中FT3和TSH水平较不稳定型心绞痛患者明显降低（P＜0.05），而FT4水平在两组中差异无统计学意义（P＞0.05）。同时，急性心肌梗死患者中总胆固醇、低密度脂蛋白胆固醇和高敏C反应蛋白水平较不稳定型心绞痛患者明显升高（P＜0.05，P＜0.01）。FT3水平与年龄、总胆固醇及高敏C反应蛋白水平呈线性相关，应用ROC曲线分析FT3水平对住院期间心血管事件死亡率预测价值，ROC曲线下面积为0.852，具有较好的预测价值。分别分析ST段抬高型和非ST段抬高型心肌梗死患者中甲状腺激素及血脂水平，两组间差异无统计学意义（P＞0.05）。结论 急性心肌梗死患者中FT3，TSH水平下降，FT3水平的变化对住院期间心血管事件死亡率具有较好预测价值。

Abstract:

Objective To observe the features and cause of thyroid hormones changes in acute myocardial infarction(AMI) patients, and evaluate their value in the short-term prognosis the patients. Methods Totally 172 patients diagnosed as AMI patients without previows thyroid disorder in our hospital from October 2010 to October 2012 were enrolled, and 92 unstable angina pectoris patients were included as control group. The levels of free tri-iodothyronine (FT3), free tetra-iodothyronine (FT4), thyroid stimulating hormone (TSH), high sensitivity C-reactive protein (hs-CRP) and blood lipids were determined in all patients on the next day of admission. Cardiovascular mortality events of these patients in hospital were also recorded. Results Serum FT3, FT4 and TSH in the AMI group were (2.33±0.47)ng/L, (12.5±2.4)ng/L and (1.32±0.99)μU/L, respectively. While in the angina group, serum FT3, FT4 and TSH were (2.80±0.54)ng/L, (11.5±1.4)ng/L and (2.19±1.07)μU/L, respectively. The levels of FT3 and TSH were significantly lower in the AMI group than in the angina group (P＜0.05). No significant difference was observed in the level of FT4 between the two groups (P＞0.05). The levels of total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and hs-CRP were obviously higher in the AMI group than in the angina group (P＜0.05, P＜0.01). There was a linear correlation of FT3 with age, TC, and hs-CRP in the AMI group. When receiver operating characteristics (ROC) analysis was used to evaluate the prognostic value of FT3 for cardiovascular mortality events in the AMI group during hospitalization, the area under the ROC curve was 0.852, suggesting well prognosis value of FT3. There was no significant difference no matter in lipids and thyroid hormone levels in the AMI group between those with and without ST elevation (P＞0.05). Conclusion AMI patients have decreased levels of FT3 and TSH. Serum change of FT3 is a predictor for in-hospital cardiovascular mortality events.