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目的探讨甲状腺激素水平与急性心力衰竭患者近期和远期预后的关系。方法纳入716例急性心力衰竭患者。入院24h内采集血样测定甲状腺激素、肾功能、电解质、B型脑钠肽。根据游离三碘甲状腺原氨酸(FT3)四分位数(Quartile)水平分为4组(Q_(1~4)组)。应用logistic回归和Cox风险模型分析甲状腺激素与全因死亡的关系。结果在(19±13)个月的随访期间,死亡214例(34.6%)。随着FT3水平下降,患者全因死亡率呈上升趋势。多因素Cox分析显示FT3是30d死亡(HR=0.812,95%CI 0.615~1.009,P<0.01)和长期全因死亡(HR=0.789,95%CI 0.664~0.937,P<0.01)的独立风险因子。Kaplan-Meier显示Q_1组与Q_(2~4)组比较死亡率差异有统计学意义(P<0.01)。结论低FT3的急性心力衰竭患者近期和远期死亡率增高。
Objective To investigate the relationship between thyroid hormone levels and short-term and long-term prognosis in patients with acute heart failure. Methods A total of 716 patients with acute heart failure were enrolled. Blood samples were collected within 24 hours of admission for thyroid hormones, renal function, electrolyte, B-type brain natriuretic peptide. According to the quartile level of free triiodothyronine (FT3), the rats were divided into 4 groups (Q_ (1 ~ 4)). The relationship between thyroid hormone and all-cause mortality was analyzed by logistic regression and Cox risk model. Results During the follow-up of (19 ± 13) months, 214 patients (34.6%) died. With the decline of FT3, all-cause mortality in patients is on the rise. Multivariate Cox analysis showed that FT3 was an independent risk factor for 30 days of death (HR = 0.812, 95% CI 0.615 to 1.009, P <0.01) and long-term all-cause death (HR = 0.789,95% CI 0.664-0.937, P <0.01) . Kaplan-Meier showed that there was a significant difference in mortality between Q_1 group and Q_ (2-4) group (P <0.01). Conclusion Patients with low FT3 in acute heart failure have higher short-term and long-term mortality.