摘要
目的 观察老年慢性心力衰竭患者的甲状腺功能状态对心功能的影响及对临床预后的评估价值。方法选择有基线甲状腺功能检查的老年慢性心力衰竭（CHF）患者247例作为研究对象。根据甲状腺功能分为甲减组（43例）、亚临床甲减组（79例）和甲状腺功能正常组（125例）。比较3组的一般临床资料、心衰病程、心功能分级及再住院率、心力衰竭急性发作率、急性冠脉综合征发生率、死亡率、复合终点发生率等指标。结果 3组患者年龄、性别构成、心血管危险因素（包括高血压、高脂血症、糖尿病、吸烟）、用药情况等方面比较差异无统计学意义（P〉0.05）。甲状腺功能正常组的心衰病程平均为（3.1±0.7）年,亚临床甲减组的心衰病程平均为（4.7±0.9）年,甲减组的心衰病程平均为（5.9±0.7）年,3组心衰病程之间差异有统计学意义（F=4.126,P〈0.05）。心衰病程〉5年的甲状腺功能异常患病率为75.9%（66/87）,心衰病程3-5年的甲状腺功能异常患病率为54.1%（33/61）,心衰病程〈3年的甲状腺功能异常患病率为23.2%（23/99）,随心衰病程延长,甲状腺功能异常患病率逐渐增高（χ^2=52.031,P〈0.01）。甲减组和亚临床甲减组患者的再住院率、心力衰竭急性发作率、死亡率以及复合终点发生率均显著高于甲功正常组（P〈0.05）,且甲减组上述各项指标显著高于亚临床甲减组（P〈0.05）。3组患者的心功能分级差异有统计学意义（χ^2=19.152,P〈0.01）,随着甲状腺功能的减退,Ⅱ级心功能患者比例较少,而Ⅲ级和Ⅳ级心功能的患者比例增高。结论 甲状腺功能减退与老年慢性心力衰竭患者的心功能分级呈相关性,监测甲状腺激素水平对心功能及临床预后具有预测价值。
Objective To investigate the effects of different thyroid function in elderly patients with chronic heart failure on clinical prognosis and cardiac function. Methods The 247 elderly patients with CHF which has baseline thyroid function tests were chosen. The cases were divided into hypothyroidism group （ 43 cases ） , subclinical hypothyroidism group （79 cases） and normal thyroid function group（ 125 cases） according thyroid function. The general clinical data, duration of heart failure,cardiac function and readmission rates,the incidence of acute heart failure, acute coronary syndrome incidence, mortality, and other indicators of the incidence of the composite endpoint between the three groups were compared. Results There were no significant difference in age, gender and cardiovascular risk factors （including hypertension, hyperlipidemia, diabetes, smoking） , medications and the like in three groups of patients（ P 〉 0.05 ）. Euthyroid group average duration of heart failure was（3.1 ±0.7 ） years, subclinical hypothyroidism average duration of heart failure was （4.7 ±0.9 ） years, the average duration of heart failure hypothyroidism group was （5.9 ±0.7 ） years. The difference between the three groups of heart failure duration was significantly（ F = 4. 126 ,P 〈 0.05 ）. The prevalence of thyroid dysfunction with heart failure duration 〉 5 years was 75.9% （66/87） ,3 - 5 years was 54.1% （ 33/61 ）, 〈 3 years 23.2% （ 23/99 ）. With the extension of the duration of heart failure, the prevalence of thyroid dysfunction gradually increased（ Х^2 = 52. 031, P 〈 0.01 ）. The admission rates, heart failure exacerbation, mortality and incidence of the composite end point in patients with hypothyroidism and sub-clinical hypothyroidism were significantly higher than those in normal thyroid function group（ P 〈 0.05 ） , and indexes above in hypothyroidism group were significantly higher than those in the subclinical hypothyroidism group （P 〈 0.05 ）. NYHA difference in three groups were significantly different （Х^2= 19. 152, P 〈 0.01 ） , with the loss of thyroid function, the proportion of Ⅱ grade of patients with cardiac function is small, while the proportion of patients with grade m and Ⅳ cardiac function increased. Conclusion Hypothyroidism and elderly patients with chronic heart failure NYHA has relevance and monitoring thyroid hormone levels have predictive value for heart function and its prognosis.
出处
《中华全科医学》
2016年第2期219-221,共3页
Chinese Journal of General Practice
关键词
甲状腺功能减退
老年
心力衰竭
心功能
预后
Thyroid dysfunction
Elderly
Heart failure
Cardiac function
Prognosis
