摘要
目的 探讨血清游离三碘甲状腺原氨酸(FT3)及心脏磁共振成像(CMRI)在扩张型心肌病患者长期预后中的价值.方法 连续入选2010年1月至2011年10月期间在中国医学科学院阜外医院住院并行甲状腺功能检测及CMRI检查的扩张型心肌病患者220例.根据患者FT3的中位数水平及CMRI是否存在钆对比剂延迟强化(LGE),分为以下四组:LGE(阳性)+FT3<2.79 pg/ml(n=56),LGE(阳性)+FT3≥2.79 pg/ml(n=45),LGE(阴性)+FT3<2.79 pg/ml(n=54)和LGE(阴性)+FT3≥2.79 pg/ml(n=65).研究终点为心脏性猝死、心力衰竭(心衰)死亡或心脏移植联合终点.采用Kaplan-Meier法绘制生存曲线,多因素Cox回归分析比较四组患者与终点事件的关系.结果 患者中位随访61个月后,59例(26.8%)患者发生终点事件,其中LGE(阳性)+FT3<2.79 pg/ml组,LGE(阳性)+FT3≥2.79 pg/ml组,LGE(阴性)+FT3<2.79 pg/ml组和LGE(阴性)+FT3≥2.79 pg/ml组终点事件率分别为51.8%(29/56)、24.4%(11/45)、22.2%(12/54)及10.8%(7/65),组间比较差异有统计学意义(P<0.001).多因素Cox回归分析显示,LGE(阳性)+FT3<2.79 pg/ml组患者发生心脏性猝死、心衰死亡或心脏移植的风险明显高于LGE(阴性)+FT3≥2.79 pg/ml组患者(HR=4.643,95%CI=1.817~11.870,P=0.001).结论 血清FT3水平与CMR-LGE结合可预测扩张型心肌病患者的长期预后.
Objective To investigate the predictive value of free triiodothyronine(FT3)and cardiac magnetic resonance imaging(CMRI)in the long-term prognosis of patients with dilated cardiomyopathy(DCM).Methods Two hundred and twenty patients hospitalized at the Chinese Academy of Medical Sciences,Fuwai hospital from January 2010 to October 2011,with the diagnosis of DCM,were consecutively enrolled in our study.All patients enrolled underwent the test of thyroid function and CMR.Patients were divided into four groups according to the level of FT 3(median level of 2.79 pg/ml)and the presence or absence of late gadolinium enhancement(LGE)detected by CMRI:LGE-positive+FT3<2.79 pg/ml(n=56),LGE-positive+FT3≥2.79 pg/ml(n=45),LGE-negative+FT3<2.79 pg/ml(n=54)and LGE-negative+FT3≥2.79 pg/ml(n=65).The endpoint of our study included the events of sudden cardiac death(SCD),death caused by heart failure or cardiac transplantation.The association of events and four groups was assessed by Kaplan-Meier survival curve and multivariable Cox regression hazard model.Results There were 59(26.8%)endpoint events including SCD,death caused by heart failure or cardiac transplantation occurred during the median follow-up of 61 months.There was a significant difference between the four groups(P<0.001).The rates of endpoint events were 51.8%(29/56),24.4%(11/45),22.2%(12/54)and 10.8%(7/65)in the patients with LGE-positive+FT3<2.79 pg/ml,LGE-positive+FT3≥2.79 pg/ml,LGE-negative+FT3<2.79 pg/ml and LGE-negative+FT3≥2.79 pg/ml,respectively.In multivariable Cox regression analysis,the adjusted risk of the endpoint events was 4.643 times higher in the LGE-positive+FT3<2.79 pg/ml group than the LGE-negative+FT3≥2.79 pg/ml group(95%CI=1.817-11.87,P=0.001).Conclusions The combination of FT3 and LGE detected by CMRI provides predictive value for the long-term prognosis in patients with DCM.
作者
刘斯思
孟祥彬
王文尧
张阔
祁雨
安仕敏
王思远
郑济林
高传玉
唐熠达
Liu Sisi;Meng Xiangbin;Wang Wenyao;Zhang Kuo;Qi Yu;An Shimin;Wang Siyuan;Zheng Jilin;Gao Chuanyu;Tang Yida(Department of Internal Medicine,Coronary Heart Disease Center,State Key Laboratory of Cardiovascular Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)
基金
北京市首都临床特色应用研究重点课题(Z151100004015175)
北京市自然科学基金(7152123).
关键词
心肌病
扩张型
三碘甲状腺原氨酸
磁共振成像
预后
Cardiomyopathy,Dilated
Triiodothyronine
Magnetic resonance imaging
Prognosis
