论文部分内容阅读
目的分析心尖肥厚型心肌病(AHCM)患者基础甲状腺素水平对其预后的影响。方法连续入选自2008年7月至2012年8月经超声心动图和/或心脏磁共振成像确诊为AHCM的患者共142例,根据其基础血清促甲状腺激素(TSH)水平分成三组:TSH<0.55、0.55–4.78、>4.78 uIU/mL,并对AHCM患者的预后进行分析。结果在142例AHCM患者中,平均年龄(58.23±10.95)岁,男性112例,占78.87%,女性30例,占21.13%。平均随访时间(4.65±1.09)年,随访成功率97.18%。此组患者中甲状腺功能减退的比例总计占到9.15%,其中低T3综合征4例(2.82%),亚临床甲减8例(5.63%),临床甲减1例(0.7%)。远期预后方面,无论是单因素、多因素Cox分析,还是Kaplan-Meier生存曲线,均提示TSH>4.78 uIU/mL是影响预后的独立危险因素,随着TSH增大,患者预后不良。对成功随诊的138例AHCM患者的Cox比例风险回归模型多因素分析表明,TSH水平、N端B型脑钠肽前体(NT-pro BNP)和高敏C反应蛋白(Hs CRP)是预后的独立影响因素,风险比分别为13.522(95%CI:2.798-65.337,P<0.005)、12.695(95%CI:1.084-14.869,P=0.043)和1.169(95%CI:1.001-1.366,P=0.048)。结论对于心尖肥厚型心肌病患者,TSH>4.78 uIU/mL是影响预后的独立危险因素。
Objective To analyze the effect of basal thyroxine on prognosis in patients with apical hypertrophic cardiomyopathy (AHCM). Methods A total of 142 consecutive patients enrolled in AHCM diagnosed by echocardiography and / or cardiac magnetic resonance imaging from July 2008 to August 2012 were divided into three groups according to their basal serum thyrotropin (TSH) levels: TSH <0.55 , 0.55-4.78,> 4.78 uIU / mL, and the prognosis of AHCM patients were analyzed. Results Among 142 patients with AHCM, the average age was (58.23 ± 10.95) years old, 112 males (78.87%) and 30 females (21.13%). The average follow-up time (4.65 ± 1.09) years, the follow-up success rate of 97.18%. In this group, the proportion of hypothyroidism accounted for a total of 9.15%, including low T3 syndrome in 4 cases (2.82%), subclinical hypothyroidism in 8 cases (5.63%) and clinical hypothyroidism in 1 case (0.7%). Long-term prognosis, whether single factor, multivariate Cox analysis, or Kaplan-Meier survival curves, suggest TSH> 4.78 uIU / mL is an independent risk factor for prognosis, with TSH increased, poor prognosis. Multivariate analysis of Cox proportional hazard regression model in 138 AHCM patients showed that TSH level, NT-pro BNP and HsCRP were prognostic The independent risk factors were 13.522 (95% CI: 2.798-65.337, P <0.005), 12.695 (95% CI: 1.084-14.869, P = 0.043) and 1.169 (95% CI: 1.001-1.366, P = 0.048). Conclusions TSH> 4.78 uIU / mL is an independent risk factor for prognosis in patients with apical hypertrophic cardiomyopathy.