低T3综合征与急性冠状动脉综合征患者冠状动脉病变程度的相关性

Correlation between low T3 syndrome and degree of coronary artery lesions in patients with acute coronary syndrome

摘要:

目的 探讨低T3综合征(LT3S)与急性冠状动脉综合征(ACS)患者冠状动脉病变程度的相关性。方法 回顾性分析2018年8月至2019年12月中国人民解放军东部战区总医院收治的204例ACS患者的临床资料,分析其甲状腺功能情况,排除甲亢、亚临床甲亢、甲减、亚临床甲减后,将其余189例患者分为甲状腺功能正常组(对照组,n=153)和低T3综合征组(n=36)。采用 SPSS 25.0 统计软件进行数据分析。根据数据类型,分别采用t检验、秩和检验或χ²检验进行组间比较。采用Spearman相关分析游离三碘甲状腺原氨酸(FT3)与Gensini评分、支架个数及B型脑钠肽的相关性。采用非条件logistic回归分析FT3与ACS患者重度冠状动脉病变的相关性,并绘制受试者工作特征(ROC)曲线判断FT3对ACS患者冠状动脉病变程度的预测价值。结果 低T3综合征组Gensini评分、支架个数及主干病变≥50%比例明显高于甲状腺功能正常组(均P<0.05)。FT3与糖尿病病史是影响ACS患者发生重度冠状动脉狭窄的独立危险因素(P<0.01)。FT3预测冠状动脉发生重度狭窄的ROC曲线下面积为0.697,最佳截断值为4.195pmol/L,灵敏度为69.8%,特异度为70.0%。结论 低T3综合征与ACS患者冠状动脉病变程度密切相关,FT3可以作为预测ACS患者冠状动脉病变程度的独立指标。

Abstract:

Objective To investigate the correlation between low triiodothyronine syndrome (LT3S) and degree of coronary artery lesions in the patients with acute coronary syndrome (ACS). Methods A retrospective study was made on clinical data of 204 ACS patients in Eastern Theater General Hospital of Chinese People′s Liberation Army from August 2018 to December 2019. After excluding those with hyperthyroidism, subclinical hyperthyroidism, hypothyroidism, and subclinical hypothyroidism based on thyroid function, the remaining 189 patients were divided into normal thyroid function group (control group, n=153) and LT3S group (n=36). SPSS 25.0 was used for data analysis. Depending on the data type, t-test, rank sum test or χ² test was used for comparison between groups. Spearman correlation analysis was used to determine the correlation between free triiodothyronine (FT3) and Gensini score, number of stents and B-type natriuretic peptide. Unconditional logistic regression analysis was employed to analyze the correlation between FT3 and severe coronary artery lesions, and the receiver operating characteristic (ROC) curve was drawn to determine the value of FT3 in predicting the degree of coronary lesions. Results Gensini score, number of stents and proportion of main lesions≥50% in the LT3S group were significantly higher than those in control group (P<0.05 for all). FT3 and a history of diabetes mellitus were independent risk factors for severe coronary stenosis in ACS patients (P<0.01). Area under the ROC curves of FT3 in predicting severe coronary stenosis was 0.697, with a best truncation value of 4.195 pmol/L, a sensitivity of 69.8%, and a specificity of 70.0%. Conclusion LT3S is closely associated with the degree of coronary artery lesions in ACS patients, and FT3 can be used as an independent index to predict the degree of coronary artery lesions in them.