急性心肌梗死患者中总三碘甲状腺原氨酸和游离甲状腺素水平对心力衰竭的预后价值。

Prognostic value of total triiodothyronine and free thyroxine levels for the heart failure in patients with acute myocardial infarction.

作者信息

Kang Min Gyu, Hahm Jong Ryeal, Kim Kye-Hwan, Park Hyun-Woong, Koh Jin-Sin, Hwang Seok-Jae, Hwang Jin-Yong, Ahn Jong Hwa, Park Yongwhi, Jeong Young-Hoon, Park Jeong Rang, Kwak Choong Hwan

机构信息

Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.

Division of Endocrinology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea.

出版信息

Korean J Intern Med. 2018 May;33(3):512-521. doi: 10.3904/kjim.2016.292. Epub 2017 Jan 11.

BACKGROUND/AIMS: Although a low triiodothyronine (T3) state is closely associated with heart failure (HF), it is uncertain whether total T3 levels on admission is correlated with the clinical outcomes of acute myocardial infarction (AMI). The aim of this study is to investigate the prognostic value of total T3 levels for major adverse cardiovascular and cerebrovascular events (MACCEs) in patients with AMI undergone percutaneous coronary intervention (PCI).

METHODS

A total of 765 PCI-treated AMI patients (65.4 ± 12.6 years old, 215 women) between January 2012 and July 2014 were included and 1-year MACCEs were analyzed. We assessed the correlation of total T3 and free thyroxine (fT4) with prevalence of 1-year MACCEs and the predictive values of total T3, fT4, and the ratio of total T3 to fT4 (T3/fT4), especially for HF requiring re-hospitalization.

RESULTS

Thirty patients (3.9%) were re-hospitalized within 12 months to control HF symptoms. Total T3 levels were lower in the HF group than in the non-HF group (84.32 ± 21.04 ng/dL vs. 101.20 ± 20.30 ng/dL, < 0.001). Receiver operating characteristic curve analysis showed the cut-offs of total T3 levels (≤ 85 ng/dL) and T3/fT4 (≤ 60) for HF (area under curve [AUC] = 0.734, < 0.001; AUC = 0.774, < 0.001, respectively). In multivariate analysis, lower T3/fT4 was an independent predictor for 1-year HF in PCI-treated AMI patients (odds ratio, 1.035; 95% confidential interval, 1.007 to 1.064; = 0.015).

CONCLUSIONS

Lower levels of total T3 were well correlated with 1-year HF in PCI-treated AMI patients. The T3/fT4 levels can be an additional marker to predict HF.

背景/目的：尽管低三碘甲状腺原氨酸（T3）状态与心力衰竭（HF）密切相关，但入院时的总T3水平是否与急性心肌梗死（AMI）的临床结局相关尚不确定。本研究的目的是探讨总T3水平对接受经皮冠状动脉介入治疗（PCI）的AMI患者主要不良心血管和脑血管事件（MACCEs）的预后价值。

方法

纳入2012年1月至2014年7月期间共765例接受PCI治疗的AMI患者（年龄65.4±12.6岁，女性215例），并分析1年MACCEs情况。我们评估了总T3和游离甲状腺素（fT4）与1年MACCEs患病率的相关性，以及总T3、fT4和总T3与fT4比值（T3/fT4）的预测价值，特别是对于需要再次住院治疗的HF。

结果

30例患者（3.9%）在12个月内因控制HF症状再次住院。HF组的总T3水平低于非HF组（84.32±21.04 ng/dL对101.20±20.30 ng/dL，P<0.001）。受试者工作特征曲线分析显示HF的总T3水平（≤85 ng/dL）和T3/fT4（≤60）的截断值（曲线下面积[AUC]=0.734，P<0.001；AUC=0.774，P<0.001）。多因素分析中，较低的T3/fT4是接受PCI治疗的AMI患者1年HF的独立预测因素（比值比，1.035；95%置信区间，1.007至1.064；P=0.015）。