目的: 探讨非ST段抬高急性心肌梗死患者合并低T3综合征时的心功能变化。方法: 收集临床诊断为非ST段抬高急性心肌梗死患者资料212例,入院时查N端-脑钠肽前体(NT-proBNP)、肌钙蛋白(cTnI)、肾功能、甲状腺功能等,根据肺部啰音进行心功能Killip分级,根据临床特征进行危险度分层。入院24 h内查床边超声心动图测量射血分数。根据甲状腺功能检查将入选患者分为低T3组与正常T3组。正常T3组126例,低T3组86例。比较组间NT-proBNP水平、肌钙蛋白水平、左室射血分数、Killip分级频数分布、危险分层的频数分布。结果: 与正常T3组相比,低T3组NT-proBNP水平升高(t=2.359,P=0.002)、心功能KillipⅢ级+Ⅳ级患者比例增多(P=0.008)、左心室射血分数降低(P=0.035)、极高危患者和基于GRACE评分的高危患者比例增加(P=0.006)、严重心血管事件(室性心动过速、室颤、心源性休克、猝死等)有所增多,但差异无统计学意义(χ2=40.743,P=0.075)。结论: 非ST段抬高急性心梗合并低T3综合征时心功能较差,病情严重。
Objective: To investigate the changes of cardiac function in non-ST-segment elevation acute myocardial infarction patients with low T3 syndrome.Methods: 212 cases of patients with non-ST-segment elevation acute myocardial infarction were enrolled in this study. NT-proBNP, cTnI, renal function and thyroid function were examined at the time of admission. Cardiac function Killip classification was made according to the lung rales and the risk stratification was made based on clinical features. The ejection fraction was measured by echocardiography within 24 hours of admission. According to the thyroid function test, the patients were divided into low T3 group and normal T3 group. NT-proBNP levels, troponin levels, left ventricular ejection fraction, Killip classification frequency distribution, and frequency distribution of risk stratification were compared between the two groups.Results: There were 126 cases in normal T3 group and 86 cases in low T3 group. Compared with normal T3 group, NT-proBNP level in low T3 group was significantly higher (P=0.002), the proportion of patients with heart function Killip grade III + IV significantly increased (P=0.008), the left ventricular ejection fraction decreased (P=0.035), the proportion of high-risk patients and high-risk patients based on GRAC scores increased significantly (P=0.006), and severe cardiovascular events (ventricular tachycardia, ventricular fibrillation, cardiogenic shock, sudden death, etc.) increased (P=0.075).Conclusion: Non-ST-elevation acute myocardial infarction with low T3 syndrome has poor heart function and serious condition.
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