目的:探讨FT3水平预测维持性血液透析患者冠心病发生发展的临床研究。方法:选择在我院行维持性血液透析的95例患者为研究对象,依据是否合并有冠心病分为冠心病组与非冠心病组,观察FT3水平及相关实验室指标差异,采用ROC曲线分析和COX多因素风险回归分析FT3水平对于MHD患者心病发生发展的预测价值。结果:冠心病组FT3、Hb、ALB浓度低于非冠心病组(P<0.05),而TG、TC、LDL-C、Hcy和Hs-CRP含量均明显高于非冠心病组(P<0.05)。FT3与Hb、ALB为明显正相关(t=0.821、0.809,P<0.05),与TG、TC、LDL-C、Hcy和Hs-CRP呈明显负相关(t=-0.814、- 0.843、- 0.904、- 0.806、- 0.912,P<0.05)。ROC曲线分析,FT3的AUC面积最高,为0.864(95%CI:0.803~0.935),敏感性和特异性分别为86.5%和89.3%,联合诊断的AUC面积为0.904(95%CI:0.867~0.976),敏感性特异性分别为85.6%和94.5%。经COX风险回归模型分析,校正上述实验室指标,FT3是MHD冠心病患者发生其不良预后的独立危险因素(HR:0.58,95%CI:0.41~0.72,P<0.05)。结论:利用FT3水平预测MHD患者冠心病发生发展具有极高临床价值,其机制可能与甲状腺素合成减少、炎性反应和动脉粥样硬化有关。

Objective: To investigate the clinical significance of FT3 level in predicting the occurrence and development of coronary heart disease in maintenance hemodialysis patients. Methods:95 patients who underwent maintenance hemodialysis in our hospital from January 2016 to December 2017 were selected as subjects. According to whether has coronary heart disease was divided into coronary heart disease group and non-coronary heart disease group, the difference of FT3 level and related laboratory indexes was observed. ROC curve analysis and COX multiple factor risk regression were used to analyze the predictive value of FT3 level on the occurrence and development of heart disease in MHD patients. Results:The concentration of FT3, Hb and ALB in CHD group was lower than that of non CHD group (P<0.05), and the content of TG, TC, LDL-C, Hcy and Hs-CRP were significantly higher than that of non CHD group (P<0.05). FT3 was positively correlated with Hb and ALB (t=0.821, 0.809, P<0.05), and was negatively correlated with TG, TC, LDL-C, Hcy and Hs-CRP (t=- 0.814,- 0.843,-0.904, - 0.806, - 0.912, P<0.05). The ROC curve analysis showed that the area of AUC of FT3 was the highest, 0.864 (95%CI: 0.803-0.935), the sensitivity and specificity was 86.5% and 89.3% respectively. The area of combined diagnosis of AUC was 0.904 (95%CI:0.867-0.976), the sensitivity and specificity was 85.6% and 94.5%, respectively. After analyzing the COX risk regression model and correcting the above laboratory indicators, FT3 is an independent risk factor (HR:0.58,5%CI:0.41-0.72, P<0.05) for the adverse prognosis of MHD patients with coronary heart disease. Conclusion:It is of high clinical value to predict the development of coronary heart disease in MHD patients by FT3 level, and its mechanism may be related to the reduction of thyroxine synthesis, inflammatory reaction and atherosclerosis.

R541.4; R692.5

西安市社会发展医学攻关项目(SF1316)