2021 年第 9 期 第 16 卷

亚临床甲状腺功能减退症对射血分数降低型急性心力衰竭患者预后的预测价值

Predictive value of subclinical hypothyroidism in progrosis of patients with acute heart failure with reduced ejection fraction

作者：张倩王春梅张慧敏王喜福高海郭畅姚威 聂绍平

英文作者：Zhang Qian Wang Chunmei Zhang Huimin Wang Xifu Gao Hai Guo Chang Yao Wei Nie Shaoping

单位：首都医科大学附属北京安贞医院冠心病中心100029

英文单位：Coronary Heart Disease Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：急性心力衰竭；亚临床甲状腺功能减低；预后

英文关键词：Acuteheartfailure；Subclinicalhypothyroidism；Progrosis

• 摘要：

• 目的 探讨亚临床甲状腺功能减退症（SCH）对射血分数降低型急性心力衰竭（AHF）患者预后的预测价值。方法 回顾性分析2016年1月至2018年12月在首都医科大学附属北京安贞医院急诊住院的射血分数降低型AHF患者1 573例。根据入院时的促甲状腺激素水平将患者分为SCH组(105例)和无SCH组(1 468例)。比较2组患者一般资料、30 d再住院率、1年全因死亡率以及2年全因死亡率，分析患者随访2年全因死亡的危险因素。结果 SCH组入院时收缩压及B型脑钠肽（BNP）水平高于无SCH组［（133±28）mmHg（1 mmHg=0.133 kPa）比（130±26）mmHg、1 982(1 195,2 644)ng/L比1 731(1 061,2 565)ng/L］，住院时间长于无SCH组［（8.6±3.3）d比（7.4±2.8）d］(均P＜0.05)。SCH组患者30 d再住院率和1年全因死亡率以及2年全因死亡率均高于无SCH组患者［41.9%（44/105）比28.3%（416/1 468）、37.1%（39/105）比26.2%（385/1 468）、52.4%（55/105）比41.5%（609/1 468）］，差异均有统计学意义（均P＜0.05）。多因素Cox回归模型分析结果显示，SCH是射血分数降低型AHF患者随访2年全因死亡的独立危险因素（风险比=1.53，95%置信区间：1.08～2.21，P=0.018），同时年龄（风险比=2.64，95%置信区间：1.67～4.15，P＜0.001）、入院BNP水平（风险比=1.83，95%置信区间：1.17～2.76，P=0.002）也是患者随访2年全因死亡的独立危险因素。结论 SCH是射血分数降低型AHF患者随访2年全因死亡的独立危险因素。

• Objective To explore the predictive value of subclinical hypothyroidism (SCH) in prognosis of patients with acute heart failure (AHF) with reduced ejection fraction. Methods A total of 1 573 patients with AHF with reduced ejection fraction admitted to Beijing Anzhen Hospital, Capital Medical University from January 2016 to December 2018 were retrospectively analyzed. The patients were divided into SCH group (105 cases) and non SCH group (1 468 cases) according to the level of thyroid stimulating hormone on admission. General data, 30 d readmission rate, 1 year all-cause mortality and 2 years all-cause mortality were compared between the two groups, and the risk factors of all-cause death were analyzed during 2 years of follow-up. Results The systolic blood pressure and brain natriuretic peptide(BNP) levels on admission in SCH group were higher than those in non SCH group［（133±28）mmHg vs （130±26）mmHg, 1 982(1 195,2 644)ng/L vs 1 731(1 061,2 565)ng/L］, and the length of stay in SCH group was longer than that in non SCH group ［（8.6±3.3）d vs （7.4±2.8）d］ (all P＜0.05). The 30 d readmission rate, 1 year all-cause mortality and 2 years all-cause mortality in SCH group were higher than those in non SCH group［41.9%（44/105） vs 28.3%（416/1 468）, 37.1%（39/105） vs 26.2%（385/1 468）, 52.4%（55/105） vs 41.5%（609/1 468）］(all P＜0.05). Multivariate Cox regression analysis showed that SCH was an independent risk factor for 2 years all-cause death during the follow-up period in AHF patients with reduced ejection fraction (hazard ratio=1.53, 95% confidence interval: 1.08-2.21, P=0.018). Age (hazard ratio=2.64, 95% confidence interval: 1.67-4.15, P＜0.001) and BNP level on admission (hazard ratio=1.83, 95% confidence interval: 1.17-2.76, P=0.002) were also independent risk factors for 2 years all-cause death during the follow-up period. Conclusion SCH is an independent risk factor for 2 years all-cause death during follow-up period in patients with AHF with reduced ejection fraction.