游离三碘甲状腺原氨酸/游离甲状腺素比值及其与GRACE风险评分联合预测接受经皮冠状动脉介入治疗的甲状腺功能正常急性心肌梗死患者预后的价值：一项前瞻性队列研究
Value of the fT3/fT4 ratio and its combination with the GRACE risk score in predicting the prognosis in euthyroid patients with acute myocardial infarction undergoing percutaneous coronary intervention: a prospective cohort study.
作者信息
Yu Tongtong, Tian Chunyang, Song Jia, He Dongxu, Wu Jiake, Wen Zongyu, Sun Zhijun, Sun Zhaoqing
机构信息
Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, People's Republic of China.
出版信息
BMC Cardiovasc Disord. 2018 Sep 10;18(1):181. doi: 10.1186/s12872-018-0916-z.
BACKGROUND
Thyroid hormones deeply influence the cardiovascular system; however, the association between the fT3/fT4 ratio and the clinical outcome in euthyroid patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) is not well defined. Therefore, the present study aimed to assess the prognostic performance of the fT3/fT4 ratio in predicting the long-term prognosis in euthyroid patients with AMI undergoing PCI.
METHODS
In a prospective cohort study with a 1-year follow-up, according to the clinical end point, 953 euthyroid individuals (61.0 ± 11.6; female, 25.8%) were divided into two groups: (1) the survival group (n = 915) and (2) the death group (n = 38).
RESULTS
According to Cox regression multivariate analysis, fT4 (HR: 1.249, 95% CI: 1.053-1.480, p = 0.010) and the fT3/fT4 ratio (HR: 3.546, 95% CI: 1.705-7.377, p = 0.001) were associated with an increased risk of 1-year all-cause mortality. The prognostic performance of the fT3/fT4 ratio was similar to the Global Registry of Acute Coronary Events (GRACE) score in predicting 1-year all-cause mortality (C-statistic: z = 0.261, p = 0.794; IDI: -0.017, p = 0.452; NRI: -0.049, p = 0.766), but better than fT4 (C-statistic: z = 2.438, p = 0.015; IDI: 0.053, p = 0.002; NRI: 0.656, p < 0.001). The fT3/fT4 ratio also significantly improved the prognostic performance of the GRACE score (GRACE score vs GRACE score + fT3/fT4 ratio: C-statistic: z = 2.116, p = 0.034; IDI: 0.0415, p = 0.007; NRI: 0.614, p < 0.001).
CONCLUSIONS
In euthyroid patients with AMI undergoing PCI, the fT3/fT4 ratio was an independent predictor of 1-year all-cause mortality. Its prognostic performance was similar to the GRACE score, and also improved its prognostic performance (GRACE score vs GRACE score + fT3/fT4 ratio).
背景
甲状腺激素对心血管系统有深远影响；然而，甲状腺功能正常的急性心肌梗死（AMI）患者接受经皮冠状动脉介入治疗（PCI）时，游离三碘甲状腺原氨酸（fT3）/游离甲状腺素（fT4）比值与临床结局之间的关联尚未明确。因此，本研究旨在评估fT3/fT4比值对接受PCI的甲状腺功能正常的AMI患者长期预后的预测性能。
方法
在一项为期1年随访的前瞻性队列研究中，根据临床终点，将953例甲状腺功能正常的个体（61.0±11.6岁；女性占25.8%）分为两组：（1）生存组（n = 915）和（2）死亡组（n = 38）。
结果
根据Cox回归多因素分析，fT4（风险比：1.249，95%置信区间：1.053 - 1.480，p = 0.010）和fT3/fT4比值（风险比：3.546，95%置信区间：1.705 - 7.377，p = 0.001）与1年全因死亡率风险增加相关。fT3/fT4比值在预测1年全因死亡率方面的预测性能与全球急性冠状动脉事件注册研究（GRACE）评分相似（C统计量：z = 0.261，p = 0.794；综合鉴别改善指数：-0.017，p = 0.452；净重新分类指数：-0.049，p = 0.766），但优于fT4（C统计量：z = 2.438，p = 0.015；综合鉴别改善指数：0.053，p = 0.002；净重新分类指数：0.656，p < 0.001）。fT3/fT4比值还显著改善了GRACE评分的预测性能（GRACE评分与GRACE评分+fT3/fT4比值比较：C统计量：z = 2.116，p = 0.034；综合鉴别改善指数：0.0415，p = 0.007；净重新分类指数：0.614，p < 0.001）。
结论
在接受PCI的甲状腺功能正常的AMI患者中，fT3/fT4比值是1年全因死亡率的独立预测因素。其预测性能与GRACE评分相似，并且还改善了GRACE评分的预测性能（GRACE评分与GRACE评分+fT3/fT4比值比较）。
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