中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2015年
2期
150-154
,共5页
功能正常甲状腺病综合征%甲状腺激素类%利钠肽,脑%糖尿病,2型
功能正常甲狀腺病綜閤徵%甲狀腺激素類%利鈉肽,腦%糖尿病,2型
공능정상갑상선병종합정%갑상선격소류%리납태,뇌%당뇨병,2형
Euthyroid sick syndromes%Thyroid hormones%Natriuretic peptide,brain%Diabetes mellitus,type 2
目的 探讨非甲状腺器质性疾病和非心力衰竭心血管疾病高危患者,甲状腺激素各指标与血浆N末端原脑钠肽(NT-proBNP)的相关性. 方法 将促甲状腺生成素(TSH)在正常范围的高龄(≥80岁)2型糖尿病患者166例分为功能正常甲状腺病综合征组(ESS组,62例)和正常甲状腺激素水平组(对照组,104例);对照组再根据总三碘甲状腺原氨酸(TT3)水平三分位法分为3组(低水平组26例,中水平组50例,高水平组28例),分别观察各组甲状腺激素、NT-proBNP、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白、肌酐清除率,心脏超声下左室射血分数(LVEF),慢性心脑血管疾病发生率等指标变化,NT-proBNP经对数转换为lgNT-proBNP进行分析. 结果 ESS组与对照组比较,年龄明显偏高[(86.3±5.8)岁比(85.6±5.2)岁],收缩压[(126.6±15.5) mmHg比(135.6±17.8) mmHg]、LVEF[(63.9±7.6)％比(67.4±7.5)％]明显降低,差异均有统计学意义(P＜0.01).与对照组比较,ESS组TT3[(0.89±0.17) nmol/L比(1.45±0.31) nmol/L]、FT3[(3.31±0.55)pmol/L比(3.96±0.59) pmol/L]水平明显降低,差异均有统计学意义(P＜0.01);lgNT-proBNP水平ESS组较对照组明显升高[(2.40±0.40) ng/L比(2.26±0.44) ng/L,P＜0.05],ESS组TT4较对照组明显降低[(101.80±36.11) nmol/L比(111.07±23.29) nmol/L,P＜0.05].排除年龄、收缩压、LVEF因素进行偏回归分析显示,TT3、TT4、FT3分别与lgNT-proBNP呈负相关关系(r=-0.217、-0.180、-0.174,均P＜0.05).进一步多元逐步回归分析显示,TT3为lgNT-proBNP的独立危险因素(标准化偏回归系数β '=-0.267,P＜0.01).lgNT-proBNP低水平组、中水平组和高水平组分别为(2.44±0.39) ng/L、(2.19±0.42) ng/L和(2.19±0.46) ng/L,中水平组和高水平组明显降低(P＜0.05). 结论 在正常TSH范围的高龄2型糖尿病患者中,TT3与NT-proBNP关系密切,临床检测TT3水平对于监测心功能变化具有重要意义.
目的 探討非甲狀腺器質性疾病和非心力衰竭心血管疾病高危患者,甲狀腺激素各指標與血漿N末耑原腦鈉肽(NT-proBNP)的相關性. 方法 將促甲狀腺生成素(TSH)在正常範圍的高齡(≥80歲)2型糖尿病患者166例分為功能正常甲狀腺病綜閤徵組(ESS組,62例)和正常甲狀腺激素水平組(對照組,104例);對照組再根據總三碘甲狀腺原氨痠(TT3)水平三分位法分為3組(低水平組26例,中水平組50例,高水平組28例),分彆觀察各組甲狀腺激素、NT-proBNP、總膽固醇、低密度脂蛋白膽固醇、糖化血紅蛋白、肌酐清除率,心髒超聲下左室射血分數(LVEF),慢性心腦血管疾病髮生率等指標變化,NT-proBNP經對數轉換為lgNT-proBNP進行分析. 結果 ESS組與對照組比較,年齡明顯偏高[(86.3±5.8)歲比(85.6±5.2)歲],收縮壓[(126.6±15.5) mmHg比(135.6±17.8) mmHg]、LVEF[(63.9±7.6)％比(67.4±7.5)％]明顯降低,差異均有統計學意義(P＜0.01).與對照組比較,ESS組TT3[(0.89±0.17) nmol/L比(1.45±0.31) nmol/L]、FT3[(3.31±0.55)pmol/L比(3.96±0.59) pmol/L]水平明顯降低,差異均有統計學意義(P＜0.01);lgNT-proBNP水平ESS組較對照組明顯升高[(2.40±0.40) ng/L比(2.26±0.44) ng/L,P＜0.05],ESS組TT4較對照組明顯降低[(101.80±36.11) nmol/L比(111.07±23.29) nmol/L,P＜0.05].排除年齡、收縮壓、LVEF因素進行偏迴歸分析顯示,TT3、TT4、FT3分彆與lgNT-proBNP呈負相關關繫(r=-0.217、-0.180、-0.174,均P＜0.05).進一步多元逐步迴歸分析顯示,TT3為lgNT-proBNP的獨立危險因素(標準化偏迴歸繫數β '=-0.267,P＜0.01).lgNT-proBNP低水平組、中水平組和高水平組分彆為(2.44±0.39) ng/L、(2.19±0.42) ng/L和(2.19±0.46) ng/L,中水平組和高水平組明顯降低(P＜0.05). 結論 在正常TSH範圍的高齡2型糖尿病患者中,TT3與NT-proBNP關繫密切,臨床檢測TT3水平對于鑑測心功能變化具有重要意義.
목적 탐토비갑상선기질성질병화비심력쇠갈심혈관질병고위환자,갑상선격소각지표여혈장N말단원뇌납태(NT-proBNP)적상관성. 방법 장촉갑상선생성소(TSH)재정상범위적고령(≥80세)2형당뇨병환자166례분위공능정상갑상선병종합정조(ESS조,62례)화정상갑상선격소수평조(대조조,104례);대조조재근거총삼전갑상선원안산(TT3)수평삼분위법분위3조(저수평조26례,중수평조50례,고수평조28례),분별관찰각조갑상선격소、NT-proBNP、총담고순、저밀도지단백담고순、당화혈홍단백、기항청제솔,심장초성하좌실사혈분수(LVEF),만성심뇌혈관질병발생솔등지표변화,NT-proBNP경대수전환위lgNT-proBNP진행분석. 결과 ESS조여대조조비교,년령명현편고[(86.3±5.8)세비(85.6±5.2)세],수축압[(126.6±15.5) mmHg비(135.6±17.8) mmHg]、LVEF[(63.9±7.6)％비(67.4±7.5)％]명현강저,차이균유통계학의의(P＜0.01).여대조조비교,ESS조TT3[(0.89±0.17) nmol/L비(1.45±0.31) nmol/L]、FT3[(3.31±0.55)pmol/L비(3.96±0.59) pmol/L]수평명현강저,차이균유통계학의의(P＜0.01);lgNT-proBNP수평ESS조교대조조명현승고[(2.40±0.40) ng/L비(2.26±0.44) ng/L,P＜0.05],ESS조TT4교대조조명현강저[(101.80±36.11) nmol/L비(111.07±23.29) nmol/L,P＜0.05].배제년령、수축압、LVEF인소진행편회귀분석현시,TT3、TT4、FT3분별여lgNT-proBNP정부상관관계(r=-0.217、-0.180、-0.174,균P＜0.05).진일보다원축보회귀분석현시,TT3위lgNT-proBNP적독립위험인소(표준화편회귀계수β '=-0.267,P＜0.01).lgNT-proBNP저수평조、중수평조화고수평조분별위(2.44±0.39) ng/L、(2.19±0.42) ng/L화(2.19±0.46) ng/L,중수평조화고수평조명현강저(P＜0.05). 결론 재정상TSH범위적고령2형당뇨병환자중,TT3여NT-proBNP관계밀절,림상검측TT3수평대우감측심공능변화구유중요의의.
Objective To investigate the relationship between thyroid function indexes and plasma level of N-terminal pro-brain natriuretic peptide (NT-proBNP) among patients who had high risks for cardiovascular diseases without thyroid diseases and heart failure.Methods Totally 166 elderly type 2 diabetic patients aged 80 years and over with normal range of thyroid stimulating hormone (TSH) were divided into group of euthyroid sick syndrome (ESS,n=62) and group of normal thyroid hormones (NESS,n=104).The patients in normal thyroid hormones group were divided into three subgroups according to the levels of total triiodothyronine (TT3),(low-level group,n=26; middle-level group,n=50; high-level group,n=28).Levels of thyroid hormones,NT-proBNP,cholesterol,low-density lipoprotein cholesterol,fibrinogen,HbA1C,glomerular filtration rate (eGRF),left ventricular ejection fraction (LVEF) and the incidences of concomitant diseases were measured and detected.lgNT-proBNP was used to calculated after NT-proBNP was changed by Log transformation.Results Compared with NESS group,ESS group showed that age was increased,systolic pressure and LVEF were decreased [(86.3 ± 5.8) years vs.(85.6 ± 5.2) years,(126.6±15.5) mmHg vs.(135.6±17.8) mmHg,(63.9±7.6)％ vs.(67.4±7.5)％,all P＜0.01].Compared with NESS group,ESS group showed that the levels of serum total T3 and free T3 were decreased [(0.89±0.17) nmol/L vs.(1.45±0.31) nmol/L,(3.31±0.55) pmol/L vs.(3.96± 0.59) pmol/L,both P＜0.01].The lgNT-proBNP level was higher and serum total thyroxine (TT4) level was lower in ESS group than in NESS group [(2.40±0.40) ng/L vs.(2.26±0.44) ng/L,(101.80±36.11) nmol/L vs.(111.07±23.29) nmol/L,both P＜0.05].Pearson analysis revealed that serum levels of TT3,TT4 and FT3 were negatively correlated with lgNT-proBNP (r=-0.217,-0.180,-0.174,respectively,all P＜0.05) after adjustment for age,systolic pressure and LVEF.Stepwise regressive analysis showed TT3 was the risk factors for lgNT-proBNP (β=-0.267,P＜ 0.01).Compared with the low-level group,the lgNT-proBNP were significantly reduced in the middle-,and high-level groups [(2.19±0.42) ng/L,(2.19±0.46) ng/L vs.(2.44±0.39) ng/L,both P＜0.05].Conclusions TT3 has a close correlation with NT-proBNP in elderly type 2 diabetic patients with normal TSH.It has a significant meaning to test TT3 level for monitoring heart function in clinical medicine.
