CAJ | 학술논문

目的本研究通过检测急性心肌梗死(AMI)患者入院血游离三碘甲状腺原氨酸(FT3)水平,探讨非甲状腺病态综合征(non-thyroid sick syndrome,NTIS)与AMI近期和远期死亡率的关系.方法入选1019例新诊断AMI患者,根据入院24 h内血FT3四分位数(Quartile)水平分成1～4组;生存组和死亡组;甲状腺功能正常组和NTIS组.随访6～ 90个月,中位随访时间为44.5个月,采用logistic逐步回归和Cox比例风险模型,比较NTIS和FT3水平对AMI近期及远期死亡的相关关系.结果 NTIS发病率占AMI患者的27.78％.随着FTT3的降低和FT3/FT4比值的降低,全因死亡率逐渐增高(Quartile 1组为9.4％,Quartile 2组为13.8％,Quartile 3组为14.3％,Quartile 4组为34.0％,P＜0.01).经过校正,FT3(RR=0.212,95％ CI0.125 ～0.359)为30 d内死亡最强的影响因素.多因素Cox回归分析显示FT3(RR=0.674,95％ CI 0.514 ～0.885)与长期全因死亡独立相关.Kaplan-Meier显示Quartile4组与Quartile 1～3组比较死亡率差异有统计学意义.即使FT3水平在正常范围低值,也与心梗全因死亡相关.结论 NTIS在AMI患者中常见.经过校正后FT3是30d短期死亡的最强预测因子,低FT3水平是影响AMI患者远期全因死亡率的独立危险因素,同时显示即使FT3水平在正常范围低值,仍与AMI全因死亡相关.
목적 본연구통과검측급성심기경사(AMI)환자입원혈유리삼전갑상선원안산(FT3)수평,탐토비갑상선병태종합정(non-thyroid sick syndrome,NTIS)여AMI근기화원기사망솔적관계.방법 입선1019례신진단AMI환자,근거입원24 h내혈FT3사분위수(Quartile)수평분성1～4조;생존조화사망조;갑상선공능정상조화NTIS조.수방6～ 90개월,중위수방시간위44.5개월,채용logistic축보회귀화Cox비례풍험모형,비교NTIS화FT3수평대AMI근기급원기사망적상관관계.결과 NTIS발병솔점AMI환자적27.78％.수착FTT3적강저화FT3/FT4비치적강저,전인사망솔축점증고(Quartile 1조위9.4％,Quartile 2조위13.8％,Quartile 3조위14.3％,Quartile 4조위34.0％,P＜0.01).경과교정,FT3(RR=0.212,95％ CI0.125 ～0.359)위30 d내사망최강적영향인소.다인소Cox회귀분석현시FT3(RR=0.674,95％ CI 0.514 ～0.885)여장기전인사망독립상관.Kaplan-Meier현시Quartile4조여Quartile 1～3조비교사망솔차이유통계학의의.즉사FT3수평재정상범위저치,야여심경전인사망상관.결론 NTIS재AMI환자중상견.경과교정후FT3시30d단기사망적최강예측인자,저FT3수평시영향AMI환자원기전인사망솔적독립위험인소,동시현시즉사FT3수평재정상범위저치,잉여AMI전인사망상관.
Objective The prognosis of patients with acute myocardial infarction (AMI) is related to age,comorbidities,and other factors,in which non-thyroid sick syndrome (NTIS) may also be an important factor.In this study,determination of blood free triiodothyronine (FT3) was used to explore the short-term and long-term mortality relationship of NTIS with acute myocardial infarction.Methods A total of 1 019 cases of newly diagnosed patients with acute myocardial infarction were enrolled.According to FT3 levels,the enlisted subjects were divided into Quartile 1-4 groups; survival group and non-survival group; normal thyroid function and NTIS group.The enrolled subjects were followed-up for 6-90 months,with the median follow-up time of 44.5 months.Using logistic regression and Cox hazards model,the relationships of short-term and long-term mortality in AMI with NTIS or FT3 were compared.Results The incidence of NTIS in patients with AMI was 27.78％.With the progressively decreasing FT3 and FT3/FT4 ratio,the mortality rates were progressively increased (Quartile 1 group 9.4％,Quartile 2 group 13.8％,Quartile 3 group 14.3％,Quartile 4 group 34.0％,P＜0.01).After being adjusted,FT3 was the strongest influencing factor of mortality within 30 days (RR =0.212,95％ CI 0.125-0.359).Multivariate Cox regression analysis showed that FT3 was independently associated with long-term mortality (RR =0.674,95％ CI 0.514-0.885).Kaplan-Meier showed significant difference in mortality between quartile 1-3 groups and the Quartile 4 group.Even FT3 level was within the low normal range,it was related with the mortality in AMI.Conclusions NTIS is common in patients with AMI.After being adjusted,FT3 was the strongest predictor of mortality within 30 days,and low FT3level in AMI patients was an independent risk factor for long-term all-cause mortality.Even FT3 level was within the normal range,it was still related with mortality in myocardial infarction.