低T3对冠状动脉病变严重程度及患者预后的影响.pdf

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实用医学杂志2014年第30卷第7期
调査硏究
低T3对冠状动脉病变严重程度及
患者预后的影响
白民富高传玉杨朝宽王宪沛
摘要目的:分析行冠状动脉造影术(CAG)的游离三碘甲状腺原氪酸(f3)降低患者冠状动脉病变(冠
脉病变)严重程度及预后。方法:连续入选2011年8月至2012年8月期间行CAC的冠心病疑诊患者600
例,按造影前甲状腺功能分为甲状腺功能正常组(450例)和低T3组(150例)。择期行CAG,运用 Gensini评
分评价冠脉病变严重程度,随访心血管事件。结果:低T3组患者冠心病发病率明显高于甲状腺功能正常组
(P=0.01);多自変量 Logistic回归分析表明I3是冠心病的保护因素(OR=0.351,P<0.001);低T3组冠脉
病变程度比甲状腺功能正常组重,差异具有统计学意义(P<0.001);平均随访(15.4±3.6)个月,与甲状腺
功能正常组比較,低T3组患者复合终点事件(全因死亡、非致命性心梗和靶血管血运重建)的发生率显著
升高(P=0.023)。結论:T3降低患者冠心病发病率高,冠脉病变严重程度增加,且预后差。
关键词冠心病;低T3综合征;甲状腺功能减退症;冠状动脉造影术
Effects of low T3 level on the severity of coronary artery lesions and prognosis BA I Min-fu', GAO Chuan
yu, YANG Chao-uan, WANG Xian-pei. *Department of Cardiology, First A iliated Hospital, Zh
University, Zhengzhou 450052, China
Correspondingauthor:YANGChao-huanE-mailyangck123@sina.com
(Abstract Objective To analyze the severity of coronary artery lesions and the prognosis in patients with
low levels of free triiodothyronine(FT3 )undergoing coronary angiography(CAG).Methods From August 2011 Lo
2012, 600 consecutive suspected patients with coronary heart disease (CHD) who undergone CAG were
selected. The patients were divided into two groups based on thyroid function prior to CAG: euthyroidism group(450
patients and low 3 group (150 patients All the patients underwent elective coronary angiography, then the
everity of coronary artery lesions was assessed by the Gensini scores, and the patients were followed up for
cardiovascular events. Results The incidence rate of CHD in low T3 group was significantly higher than that
euthyroidism group( P=0.01 ).Multiple variables logistic regression analysis showed that f3 was a protective factor
for CHD(OR =0.351, P <0.001); The severity of coronary artery lesions was greater in low T3 group than in
euthyroidism group(P< 0.001) The mean duration of follow-up was(15.4+3.6)months; the incidence of the
composite end-point ea h, non-fatal myocardial infarction and target vessel revascularization was significantly
higher in low T3 group than in euthyroidism group (P =0.023). Conclusions Patients with a decreased T3 level
has a higher incidence rate of CHID, an increase in the severity of coronary artery lesions, and a poorer prognosis
(Key words) Coronary disease; Low T3 syndrome; Hypothyroidism Coronary angiography
心血管系统是甲状腺激素作用的主要靶器官征增加急性心肌梗死患者的死亡率,并且是心源
之一,约80%具有活性的游离三碘甲状腺原氨酸性死亡的一个强烈预测因子日。然而fI3降低患者
(3)由甲状腺素(T4)脱碘生成,发挥生物学效的冠状动脉病变(冠脉病变)严重程度及预后与
应,临床和实验表明m3在调节心率、心肌收缩力fT3正常者是否相同?这方面国内的研究很少。本
及血压方面起到主要作用。3降低包括甲状腺研究旨在探讨疑诊冠心病的3降低患者冠脉病
功能减退症和低T3综合征,T3水平与冠心病的发变严重程度及预后,为临床冠心病的危險分层提
生率呈负相关2?,甲状腺功能减退症(甲减)加速动供依据
脉粥样硬化进程且增加冠心病的风险,低T3综合
对象与方法
1.1研究对象2011年8月至2012年8月连续
doi:10.3969/jisa.100-5725,2014.07,047
入选郑州大学人民医院心内科冠心病疑诊患者共
作者单位:4500郑州大学第一附属医院(自民高):400600例,男405例,女195例,平均年龄(65.7±9.6
郑州大学人民医院(高传玉,王宪沛);451191郑州市,河南职工医
学院(杨朝宽
岁。人选标准:有胸痛或胸闷的症状,心电图ST段
通信作者:杨朝宽E-mil:yangck123@sina.com
压低或T波倒置,或既往运动平板试验结果阳性