摘要
目的 探究血清半乳凝素-3(Gal-3)、同型半胱氨酸(Hcy)和甲状腺功能水平与急性心肌梗死患者心力衰竭程度及预后的相关性.方法 回顾性选取2018年4月至2020年4月在秦皇岛市第一医院接受治疗的100例急性心肌梗死患者,根据患者是否发生心力衰竭将患者分组:56例患者未发生心力衰竭,纳入对照组,其他44例发生心力衰竭的患者纳入观察组.比较2组患者的血清Gal-3、Hcy和游离三碘甲腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平;根据Killip分级将观察组患者分为轻度组(n=16)、中度组(n=19)、重度组(n=9),比较3组患者的Gal-3、Hcy、FT3、FT4、TSH水平;对观察组患者进行1年随访,根据患者随访期内是否发生主要心血管不良事件(MACE)将患者分为预后良好组(n=28)和预后不良组(n=16),比较2组患者的Gal-3、Hcy、FT3、FT4、TSH水平.采用受试者操作特征(ROC)曲线分析Gal-3、Hcy、FT3、FT4、TSH水平对患者预后的预测价值.结果 观察组患者的Gal-3、Hcy、TSH 水平分别为(13.33±3.87)μg/L、(19.11±3.16)μmol/L、(8.49±2.46)mIU/L,均高于对照组[(9.98±3.12)μg/L、(16.56±3.05)μmol/L、(6.45±2.04)mIU/L],FT3、FT4 水平分别为(1.25±0.56)、(6.45±1.78)pmol/L,均低于对照组[(1.55±0.31)、(7.56±1.25)pmol/L],差异均有统计学意义(P＜0.05).不同程度心力衰竭患者组间Gal-3、Hcy、FT3、FT4、TSH水平比较,差异均有统计学意义(P＜0.05),随着病情严重程度越重,Gal-3、Hcy、TSH水平越高,FT3、FT4水平越低.预后不良组患者的Gal-3、Hcy、TSH水平均高于预后良好组,FT3、FT4水平均低于预后良好组,差异均有统计学意义(P＜0.05).多因素Logistic回归分析结果显示,患者血清Gal-3、Hcy、FT3、FT4、TSH水平均是患者预后的影响因素(P＜0.05).Gal-3、Hcy、FT3、FT4、TSH水平预测患者预后不良的曲线下面积分别为0.985、0.877、0.942、0.916、0.969.结论 Gal-3、Hcy和甲状腺功能水平与急性心肌梗死患者心力衰竭程度及预后存在相关性,可以作为评估急性心肌梗死患者心力衰竭严重程度和预测预后的重要指标.
Abstract
Objective To explore the correlation between serum galectin-3(Gal-3),homocysteine(Hcy)and thyroid function levels and the severity and prognosis of heart failure in patients with acute myocardial infarction.Methods A total of 100 patients with acute myocardial infarction who received treatment in the First Hospital of Qinhuangdao from April 2018 to April 2020 were selected and grouped according to wheth-er they developed heart failure:56 patients without heart failure were included in the control group,and the other 44 patients with heart failure were included in the observation group.The levels of serum Gal-3,Hcy and free triiodothyronine(FT3),free thyroxine(FT4),thyroid stimula-ting hormone(TSH)in the two groups were compared.According to the Killip classification,the observation group were divided into the mild group(n=16),moderate group(n=19),and severe group(n=9),the levels of Gal-3,Hcy,FT3,FT4,and TSH among the three group were compared.Patients in the observation group were followed up for one year,and divide them into the good prognosis group(n=28)and the poor prognosis group(n=16)based on whether major cardiovascular adverse events(MACE)occurred during the follow-up period,the levels of Gal-3,Hcy,FT3,FT4,and TSH between the two groups were compared.The predictive value of Gal-3,Hcy,FT3,FT4,and TSH levels on patient prognosis were analyzed using receiver operating characteristic(ROC)curves.Results The levels of Gal-3,Hcy,and TSH in the observation group were(13.33±3.87)µg/L,(19.11±3.16)µmol/L,(8.49±2.46)mIU/L,respectively,which were higher than those in the control group[(9.98±3.12)]µg/L,(16.56±3.05)µmol/L,(6.45±2.04)mIU/L,the levels of FT3 and FT4 in the observation group were(1.25±0.56),and(6.45±1.78)pmol/L,respectively,which were lower than those in the control group[(1.55±0.31),(7.56±1.25)pmol/L],the differences were statistically significant(P＜0.05).The levels of Gal-3,Hcy,FT3,FT4,and TSH were compared be-tween groups of patients with different degrees of heart failure,and the differences were statistically significant(P＜0.05).As the severity of the condition worsened,the levels of Gal-3,Hcy,and TSH were higher,while the levels of FT3 and FT4 were lower.The levels of Gal-3,Hcy and TSH in the poor prognosis group were higher than those in the good prognosis group,while the levels of FT3 and FT4 were lower than those in the good prognosis group,the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis showed that serum levels of Gal-3,Hcy,FT3,FT4,and TSH were all factors affecting patient prognosis(P＜0.05).The area under the curve for predicting poor prog-nosis of patients with Gal-3,Hcy,FT3,FT4,and TSH levels were 0.985,0.877,0.942,0.916,and 0.969,respectively.Conclusion The levels of Gal-3,Hcy and thyroid function are correlated with the severity and prognosis of heart failure in acute myocardial infarction patients,and can be used as important indicators to evaluate and predict the severity and prognosis of heart failure in acute myocardial infarction patients.
基金项目
河北省医学科学研究项目(20211344)
秦皇岛市科学技术研究与发展计划(202004A126)
NETL
NSTL
万方数据