摘要
背景临床工作中冠心病(CAD)经皮冠状动脉介入治疗(PCI)术后患者合并甲状腺功能异常十分常见,慢性病共病模式下对于心脏结构及功能的影响尚不明确。目的探讨甲状腺功能异常对CAD-PCI术后患者心脏结构及功能的影响。方法本研究数据来源于“新疆维吾尔自治区人民医院心血管专科大数据分析平台-医渡云”,检索2013—2022年CAD-PCI术后患者的临床资料,检测甲状腺功能、心脏超声和生化指标,依据诊断标准分为临床甲状腺功能亢进组(n=263),临床甲状腺功能减退组(n=357),同时抽取300例甲状腺功能正常患者作为甲状腺功能正常组(n=300)。采用Spearman秩相关分析探究甲状腺功能与心脏结构、功能的相关性。采用多因素Logistic回归分析和非条件多因素Logistic回归分析探究心脏收缩及舒张功能不全的影响因素。绘制受试者工作特征(ROC)曲线判断甲状腺功能指标对心脏功能不全的诊断价值并计算ROC曲线下面积(AUC)。结果3组患者年龄、性别、舒张压(DBP)、收缩压(SBP)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、胱抑素C(CysC)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、B型钠尿肽(BNP)、空腹血糖(GLU)、脂蛋白a(LPa)、甲状腺素(T4)、游离甲状腺素(FT4)、三碘甲状腺原氨酸(T3)、游离三碘甲状腺原氨酸(FT3)、促甲状腺激素(TSH)、甲状腺球蛋白抗体(TgAb)、甲状腺过氧化物酶抗体(TPOAb)比较,差异有统计学意义(P<0.05)。3组患者主动脉内径(AOd)、右心室内径(RVd)、左心室舒张末期内径(LVDd)、左心室收缩末期内径(LVSd)、左心室舒张末期容积(LVEDV)、左心室射血分数(LVEF)、每搏输出量(SV)比较,差异有统计学意义(P<0.05)。Spearman秩相关分析结果显示:LVEF与FT3、T3及TSH呈正相关(P<0.05);AOd与FT3和T3呈正相关,与TgAb和TSH呈负相关(P<0.05);LVDd与FT3呈正相关,与TgAb和TSH呈负相关(P<0.05);LVSd与FT3、T3、T4和TSH呈负相关(P<0.05);SV与FT3、T3呈正相关,与TgAb呈负相关(P<0.05);RVd与FT3呈正相关,与TSH呈负相关(P<0.05);室间隔厚度(IVSd)与TgAb呈负相关(P<0.05);LVEDV与FT3呈正相关,与TgAb和TSH呈负相关(P<0.05);左心室后壁厚度(LVPWd)与TgAb呈负相关(P<0.05)。多因素Logistic回归分析结果显示,FT3、TSH是心脏收缩功能不全的影响因素(P<0.05),T4是心脏舒张功能不全的影响因素(P<0.05)。ROC曲线结果显示FT3和TSH预测心脏收缩功能不全的AUC分别为0.621(95%CI=0.581~0.662)和0.632(95%CI=0.594~0.670);T4预测心脏舒张功能不全的AUC为0.590(95%CI=0.510~0.670)。分层分析结果显示:FT3对心脏收缩功能不全的影响在年龄和性别之间无差异(P趋势>0.05),TSH对心脏收缩功能不全的影响在年龄和性别之间存在差异(P趋势<0.05),FT3、TSH对心脏收缩功能的保护作用在女性和≥60岁人群中更显著(P<0.05);T4对心脏舒张功能不全的影响在年龄和性别之间存在差异(P趋势<0.05)。结论甲状腺功能异常可以显著影响CAD-PCI术后患者心脏的结构和功能,其中FT3、TSH主要影响心脏收缩功能,T4主要影响心脏舒张功能。应更关注女性和<60岁人群中甲状腺功能对心脏功能的影响,避免舒张功能不全及高排低阻型心力衰竭的发生。
Background Thyroid dysfunction is common in patients with coronary artery disease(CAD)following percutaneous coronary intervention(PCI).However,its impact on cardiac structure and function within the context of chronic comorbidities remains unclear.Objective To investigate the effects of thyroid dysfunction on cardiac structure and function in CAD patients post-PCI.Methods Data were sourced from the"Xinjiang People's Hospital Cardiovascular Specialty Big Data Analysis Platform-Yidu Cloud"including clinical data of CAD patients post-PCI from 2013 to 2022.Thyroid function,echocardiography,and biochemical indices were measured.Patients were classified based on diagnostic criteria into clinical hyperthyroidism group(n=263),clinical hypothyroidism group(n=357),and a control group of euthyroid patients(n=300).Spearman rank correlation was used to explore the relationship between thyroid function and cardiac structure/function.Multivariate Logistic regression and unconditional multivariate Logistic regression analyses were conducted to investigate factors affecting cardiac systolic and diastolic dysfunction.Receiver operating characteristic(ROC)curves were plotted to determine the diagnostic value of thyroid function indices for cardiac dysfunction and to calculate the area under the ROC curve(AUC).Results Significant differences were observed among the three groups in age,gender,diastolic blood pressure(DBP),systolic blood pressure(SBP),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),cystatin C(CysC),alanine aminotransferase(ALT),aspartate aminotransferase(AST),B-type natriuretic peptide(BNP),fasting glucose(GLU),lipoprotein(a)(LPa),thyroxine(T4),free thyroxine(FT4),triiodothyronine(T3),free triiodothyronine(FT3),thyroid-stimulating hormone(TSH),thyroglobulin antibody(TgAb),and thyroid peroxidase antibody(TPOAb)(P<0.05).Significant differences were also found in aortic diameter(AOd),right ventricular diameter(RVd),left ventricular end-diastolic diameter(LVDd),left ventricular end-systolic diameter(LVSd),left ventricular end-diastolic volume(LVEDV),left ventricular ejection fraction(LVEF),and stroke volume(SV)(P<0.05).Spearman rank correlation analysis showed positive correlations of LVEF with FT3,T3,and TSH(P<0.05);AOd with FT3 and T3,and negative correlations with TgAb and TSH(P<0.05);LVDd with FT3,and negative correlations with TgAb and TSH(P<0.05);LVSd with FT3,T3,T4,and TSH(P<0.05);SV with FT3,T3,and negative correlation with TgAb(P<0.05);RVd with FT3,and negative correlation with TSH(P<0.05);interventricular septal thickness(IVSd)with TgAb(P<0.05);LVEDV with FT3,and negative correlations with TgAb and TSH(P<0.05);left ventricular posterior wall thickness(LVPWd)with TgAb(P<0.05).Multivariate Logistic regression indicated that FT3 and TSH were factors affecting cardiac systolic dysfunction(P<0.05),while T4 influenced cardiac diastolic dysfunction(P<0.05).ROC curve analysis revealed that the AUCs for predicting cardiac systolic dysfunction were 0.621(95%CI=0.581-0.662)for FT3 and 0.632(95%CI=0.594-0.670)for TSH;for predicting cardiac diastolic dysfunction,the AUC for T4 was 0.590(95%CI=0.510-0.670).Stratified analysis indicated no significant differences in the impact of FT3 on cardiac systolic dysfunction between different ages and genders(Ptrend>0.05),whereas TSH showed differences(Ptrend<0.05).The protective effects of FT3 and TSH on cardiac systolic function were more significant in females and individuals aged≥60 years(P<0.05).The influence of T4 on cardiac diastolic dysfunction differed by age and gender(Ptrend<0.05).Conclusion Thyroid dysfunction significantly affects cardiac structure and function in CAD patients post-PCI.FT3 and TSH primarily influence cardiac systolic function,while T4 mainly affects diastolic function.Greater attention should be given to the impact of thyroid function on cardiac function in females and individuals aged<60 years to prevent diastolic dysfunction and high-output low-resistance heart failure.
作者
王凯阳
余小林
马玲
陶静
永佳蕙
杨毅宁
WANG Kaiyang;YU Xiaolin;MA Ling;TAO Jing;YONG Jiahui;YANG Yining(Department of Cardiology,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi 830000,China;Xinjiang Key Laboratory of Cardiovascular Homeosta and Regenerative Medicine,Urumqi 830000,China)
出处
《中国全科医学》
CAS
北大核心
2024年第27期3351-3358,共8页
Chinese General Practice
基金
新疆维吾尔自治区“科技创新领军人才项目-高层次领军人才”项目(2022TSYCLJ0028)。
