| 祁子钊,裘淼涵,徐颖,边丽雅,周鹤,李晶,李毅,韩雅玲.游离三碘甲状腺原氨酸和游离甲状腺素比值与急性冠脉综合征患者使用对比剂后的急性肾损伤的相关性[J].中华老年多器官疾病杂志,2023,22(4):246~250 |
| 游离三碘甲状腺原氨酸和游离甲状腺素比值与急性冠脉综合征患者使用对比剂后的急性肾损伤的相关性 |
| Correlation between FT3/FT4 ratio and post-contrast acute kidney injury in patients with acute coronary syndrome |
| 投稿时间：2022-10-31 |
| DOI：10.11915/j.issn.1671-5403.2023.04.051 |
| 中文关键词: 急性冠脉综合征 甲状腺功能 使用对比剂后急性肾损伤 |
| 英文关键词:acute coronary syndrome thyroid function post-contrast acute kidney injury This work was supported by Liaoning Science and Technology Projects |
| 基金项目:辽宁省科学技术计划项目(2020JH1/10300002) |
| 作者 | 单位 | E-mail | | 祁子钊 | 哈尔滨医科大学附属第二医院心血管内科,哈尔滨 150086
北部战区总医院心血管内科,沈阳 110016 | | | 裘淼涵 | 北部战区总医院心血管内科,沈阳 110016 | | | 徐颖 | 北部战区总医院心血管内科,沈阳 110016 | | | 边丽雅 | 北部战区总医院心血管内科,沈阳 110016 | | | 周鹤 | 北部战区总医院心血管内科,沈阳 110016 | | | 李晶 | 哈尔滨医科大学附属第二医院心血管内科,哈尔滨 150086
北部战区总医院心血管内科,沈阳 110016 | | | 李毅 | 北部战区总医院心血管内科,沈阳 110016 | | | 韩雅玲 | 哈尔滨医科大学附属第二医院心血管内科,哈尔滨 150086
北部战区总医院心血管内科,沈阳 110016 | hanyaling@163.net |
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| 中文摘要: |
| 目的 探讨急性冠脉综合征(ACS)患者术前游离三碘甲状腺原氨酸(FT3)和游离甲状腺素(FT4)比值与使用对比剂后的急性肾损伤(PC-AKI)的相关性。方法 回顾性分析2016年1月至2017年12月在北部战区总医院心血管内科住院并接受经皮冠状动脉介入治疗(PCI)的10101例ACS患者的临床资料。根据术前实验室检查结果计算FT3/FT4比值,按照FT3/FT4比值三分位进行分组,分为FT3/FT4低水平组(FT3/FT4＜0.233,n=3152),FT3/FT4中等水平组(0.233≤FT3/FT4＜0.304,n=3636)以及FT3/FT4高水平组(FT3/FT4≥0.304,n=3313)。研究结局事件定义为ACS患者接受PCI术后PC-AKI的发生率。采用SAS 9.4软件进行数据分析。根据数据类型,组间比较分别采用单因素方差分析、Kruskal-Wallis检验及χ2检验。采用限制性立方样条图分析术前FT3/FT4比值与PC-AKI的发生的相关性。结果 3组患者的年龄、男性比例、高血压比例、糖尿病比例、既往PCI史、吸烟情况、左室射血分数(LVEF)、血红蛋白水平、FT3及FT4水平、桡动脉入路比例、靶血管位置为前降支以及术中使用对比剂用量情况比较,差异均有统计学意义(均P<0.05)。FT3/FT4低水平、中等水平及高水平组的PC-AKI发生率分别是2.95%(93/3152)、1.27%(46/3636)、1.54%(51/3313),3组间差异有统计学意义(P<0.001)。ACS患者术前FT3/FT4水平与PC-AKI发生率之间呈U型关系。以FT3/FT4比值0.305作为参考值,无论是FT3/FT4水平降低或升高,患者发生PC-AKI的风险均呈上升趋势。结论 FT3/FT4比值与ACS患者PC-AKI的发生密切相关,无论FT3/FT4水平升高或降低,PC-AKI发生风险均呈上升趋势。 |
| 英文摘要: |
| Objective To investigate the correlation between preoperative free triiodothyronine (FT3) to free thyroxine (FT4) (FT3/FT4) ratio and post-contrast acute kidney injury (PC-AKI) in the patients with acute coronary syndrome (ACS). Methods A retrospective analysis was performed of the clinical data of 10101 ACS patients undergoing percutaneous coronary intervention (PCI) in the General Hospital of Northern Theater Command from January 2016 to December 2017. The FT3/FT4 ratio was calculated based on the laboratory tests, and the patients were divided into three groups according to the FT3/FT4 ratio:low FT3/FT4 group (FT3/FT4＜0.233, n=3152),intermediate FT3/FT4 group(0.233≤FT3/FT4＜0.304, n=3636), and high FT3/FT4 group (FT3/FT4≥0.304, n=3313). The endpoint of the study was defined as the incidence of PC-AKI in the ACS patients undergoing PCI. SAS 9.4 was used for statistical analysis. Depending on data type, data comparison among three groups were performed by analysis of variance, Kruskal-Wallis test orχ2test. The correlation between preoperative FT3/FT4 ratio and the occurrence of PC-AKI was analyzed using restricted cubic spline. Results There were statistically significant differences among the three groups in age, proportion of men, proportion of hypertension, proportion of diabetes mellitus, history of previous PCI, smoking, left ventricular ejection fraction, hemoglobin level, FT3 and FT4 levels, proportion of radial artery approach, target vessel at the anterior descending branch, and intraoperative use of contrast agent (P<0.05 for all). The incidence of PC-AKI was 2.95% (93/3152), 1.27% (46/3636), and 1.54% (51/3313) in the low, intermediate, and high FT3/FT4 group, respectively, and the differences were statistically significant (P<0.001). Preoperative FT3/FT4 ratio and the incidence of PC-AKI in ACS patients showed a U-shaped relationship. Using the FT3/FT4 ratio of 0.305 as the reference value, the risk of PC-AKI tended to increase with either lower or higher FT3/FT4 ratios. Conclusion FT3/FT4 ratio is closely related to the occurrence of PC-AKI in ACS patients, and the risk of PC-AKI increases with either lower or higher FT3/FT4 ratios. |
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