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甲状腺功能亢进合并心房颤动患者的临床特征及危险因素分析

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目的 分析甲状腺功能亢进(简称甲亢)合并心房颤动患者的临床特征及预后差异。方法 采用回顾性分析,收集2004-2022年成都医学院第二附属医院收治的1 160例甲亢患者临床资料,以是否合并心房颤动为分组依据,将患者分为心房颤动组(n=581)和非心房颤动组(n=579),分析比较两组的甲状腺功能指标[游离型三碘甲状腺原氨酸(FT3)、游离型四碘甲状腺原氨酸(FT4)、促甲状腺激素(TSH)]和胆固醇、脑钠肽(BNP)、N末端脑钠肽前体(NT-proBNP)、甘油三酯(TG)水平,以及高血压史、糖尿病病史、吸烟史、左右心房(室)内径、左心室射血分数(LVEF)、美国纽约心脏病学会(NYHA)分级。对上述可能的危险因素进行多因素logistic回归分析。结果 两组的年龄、FT3、TSH、左心房内径、LVEF、NYHA分级、BNP和NT-proBNP比较,差异均有统计学意义(P<0。05)。多因素logistic回归分析结果显示,左心房内径偏大、TSH偏低和BNP偏高是甲亢患者发生心房颤动的独立危险因素(P<0。05)。以上述3项指标预测甲亢患者发生心房颤动的受试者工作特征(ROC)曲线结果显示,左心房内径的曲线下面积明显高于TSH和BNP,差异有统计学意义(P<0。05)。结论 甲亢患者左心房内径增大、TSH下降、BNP上升时,发生心房颤动的风险增大。
Clinical features and risk factors analysis of patients with hyperthyroidism complicating atrial fibrillation
Objective To analyze the clinical characteristics and prognosis differences of the patients with hyperthyroidism complicating atrial fibrillation.Methods A retrospective analysis was adopted.The clinical data of 1 160 patients with hyperthyroidism admitted and treated in the Second Affiliated Hospital of Chengdu Medical College during 2004-2022 were collected.The patients were divided into the atrial fibrilla-tion group(n=581)and non-atrial fibrillation group(n=579)according to whether complicating atrial fibril-lation.Then the levels of thyroid functional indicators[free triiodothyronine(FT3),free tetraiodothyronine(FT4),thyroid-stimulating hormone(TSH)],cholesterol,brain natriuretic peptide(BNP),N-terminal brain natriuretic peptide precursor(NT-proBNP)and triglyceride(TG)as well as the hypertension history,diabetic history,smoking history,inner diameter of left and right atrium(ventricle),ejection fraction and NYHA grade were analyzed and compared between the two groups.The multivariate logistic regression analysis was per-formed for the above possible risk factors.Results There were statistically significant differences in the age,FT3,TSH,left atrial diameter,LVEF,NYHA grade,BNP and NT-proBNP between the two groups(P<0.05).The multivariate logistic regression analysis results showed that left atrial inner diameter rather large,TSH rather low and BNP rather high were the independent risk factors for atrial fibrillation occurrence in the patients with hyperthyroidism.The results of receiver operating characteristic(ROS)curve of above 3 indica-tor in predicting the occurrence of atrial fibrillation occurrence in the patients with hyperthyroidism showed that the area under the curve of left atrial inner diameter was significantly higher than that of TSH and BNP,and the differences were statistically significant(P<0.05).Conclusion When the left atrial inner diameter in the patients with hyperthyroidism is enlarged,TSH is decreased and BNP is increased,the risk of atrial fibril-lation occurrence is increased.

hyperthyroidismatrial fibrillationleft atrial enlargementthyroid-stimulating hormonebrain natriuretic peptide

张成伟、吴奇、陈巍、李小平

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西南医科大学临床医学院心血管内科,四川泸州 646000

成都医学院第二附属医院/核工业四一六医院心血管内科,成都 610500

电子科技大学附属医院/四川省人民医院超声心脏电生理学与生物力学四川省重点实验室,成都 610072

电子科技大学附属医院/四川省人民医院心内科,成都 610072

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甲状腺功能亢进 心房颤动 左心房内径 促甲状腺激素 脑钠肽

国家自然科学基金项目四川省成都市卫生健康委员会科研课题

817703792023234

2024

重庆医学
重庆市卫生信息中心,重庆市医学会

重庆医学

CSTPCD
影响因子:1.797
ISSN:1671-8348
年,卷(期):2024.53(12)
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