游离三碘甲状腺原氨酸对扩张型心肌病患者的预后价值。

Prognostic value of free triiodothyronine in patients with dilated cardiomyopathy.

机构信息

Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu 210029, China.

Department of Cardiology, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu 213003, China.

出版信息

Chin Med J (Engl). 2020 Sep 20;133(18):2170-2176. doi: 10.1097/CM9.0000000000000896.

DOI:10.1097/CM9.0000000000000896

PMID:32604179

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7508441/

Abstract

BACKGROUND

The association between free triiodothyronine (FT3) and long-term prognosis in dilated cardiomyopathy (DCM) patients has not been evaluated. The purpose of this study was to determine whether the level of FT3 could provide prognostic value in patients with DCM.

METHODS

Data of consecutive patients diagnosed with DCM were collected from October 2009 to December 2014. FT3 was measured by fluoroimmunoassay. Other biochemical markers, such as free thyroxin (FT4), thyroid-stimulating hormone, red blood cell, hemoglobin, blood urea nitrogen, and serum creatinine, were tested at the same time. Follow-up was performed every 3 months. The primary endpoint was all-cause mortality. Pearson analysis was used to evaluate the correlation of FT3 and other lab metrics with DCM patients' prognosis. The association of long-term mortality in DCM and FT3 was compared using Cox hazards model.

RESULTS

Data of 176 patients diagnosed with DCM were collected. Of them, 24 patients missed FT3 values and six patients were lost to follow-up. Altogether, data of 146 patients were analyzed. During the median follow-up time of 79.9 (53.5-159.6) months, nine patients lost, 61 patients died (non-survival group), and 85 patients survived (survival group). FT3 was significantly lower in non-survival group than that in survival group (3.65 ± 0.83 pmol/L vs. 4.36 ± 1.91 pmol/L; P = 0.003). FT3 also showed a significantly positive correlation with red blood cell and hemoglobin, negatively correlated with age, blood urea nitrogen and serum creatinine (P < 0.05), respectively. Patients in the group of lower FT3 levels (FT3 ≤3.49 pmol/L) suffered from a higher risk of all-cause mortality (P for log-rank = 0.001). In multivariate Cox regression analysis, FT3 level was significantly associated with all-cause mortality (hazard ratio: 0.70, 95% confidence interval 0.52-0.95, P for trend = 0.021).

CONCLUSION

Low levels of FT3 were associated with increased all-cause mortality in patients with DCM.

摘要

背景

游离三碘甲状腺原氨酸（FT3）与扩张型心肌病（DCM）患者的长期预后之间的关系尚未得到评估。本研究的目的是确定 FT3 水平是否能为 DCM 患者提供预后价值。

方法

收集 2009 年 10 月至 2014 年 12 月连续诊断为 DCM 的患者的数据。FT3 通过荧光免疫分析法测定。同时检测其他生化标志物，如游离甲状腺素（FT4）、促甲状腺激素、红细胞、血红蛋白、血尿素氮和血清肌酐。每 3 个月进行一次随访。主要终点为全因死亡率。Pearson 分析用于评估 FT3 与其他实验室指标与 DCM 患者预后的相关性。采用 Cox 风险模型比较 DCM 患者长期死亡率与 FT3 的关系。

结果

共收集了 176 例诊断为 DCM 的患者的数据。其中，24 例患者 FT3 值缺失，6 例患者失访。共分析了 146 例患者的数据。在中位随访时间 79.9（53.5-159.6）个月期间，9 例患者失访，61 例患者死亡（非生存组），85 例患者存活（生存组）。非生存组 FT3 明显低于生存组（3.65±0.83 pmol/L 比 4.36±1.91 pmol/L；P=0.003）。FT3 与红细胞和血红蛋白呈显著正相关，与年龄、血尿素氮和血清肌酐呈显著负相关（P<0.05）。FT3 水平较低（FT3≤3.49 pmol/L）的患者全因死亡率更高（对数秩检验 P=0.001）。多因素 Cox 回归分析显示，FT3 水平与全因死亡率显著相关（危险比：0.70，95%置信区间 0.52-0.95，趋势 P=0.021）。