【摘要】：[目的]分析心臟移植的終末期心衰患者的基線甲狀腺激素水平對心臟移植術(shù)后圍手術(shù)期恢復(fù)及遠期預(yù)后的影響。[方法]連續(xù)入選2009年9月至2014年7月在我院接受心臟移植的終末期心衰患者共計270例,按以下兩種方式進行分組,根據(jù)其基礎(chǔ)血清促甲狀腺激素(TSH)水平分成三組：TSH0.55、0.55-2.5、2.5mIU/L。根據(jù)血清游離三碘甲狀腺原氨酸(fT3)水平分成三組：fT3≤2.36、2.37-2.79.≥2.80pg/ml。觀察其圍術(shù)期恢復(fù)狀況及遠期預(yù)后。[結(jié)果]本研究入選270例患者,平均年齡44.58±13.30歲,男性228例,占84.4%,女性42例,占15.6%。術(shù)后平均隨訪時間31.88±17.48個月,隨訪率100%。此組患者中甲狀腺功能減退的比例總計占到41.8%,其中低T3綜合征46例(17%),亞臨床甲減56例(20.7%),臨床甲減11例(4.1%)。心臟移植患者的甲狀腺激素水平低下的比例遠高于一般人群。圍手術(shù)期恢復(fù)狀況,不同TSH分組下重癥監(jiān)護室(ICU)停留時間和機械通氣時間未見統(tǒng)計學(xué)差異(P0.05),但均以TSH:0.55-2.5mIU/L組為最低,TSH2.5mIU/L組為最高。遠期預(yù)后方面,無論是單因素還是多因素COX分析,還是Kaplan-Meier生存曲線,均提示TSH2.5mIU/L是影響預(yù)后的獨立危險因素,隨著TSH增大,患者預(yù)后不良。不同fT3分組下重癥監(jiān)護室(ICU)停留時間和機械通氣時間未見統(tǒng)計學(xué)差異(P0.05),不同fT3對心臟移植手術(shù)的遠期預(yù)后的影響均未見統(tǒng)計學(xué)意義(P0.05)。[結(jié)論]對于終末期心衰行心臟移植的患者,TSH≥2.5mIU/L是影響預(yù)后的獨立危險因素。
[Abstract]:Objective: to analyze the effect of baseline thyroid hormone level on perioperative recovery and long-term prognosis in patients with end-stage heart failure after heart transplantation. [methods] A total of 270 consecutive patients with end-stage heart failure received heart transplantation in our hospital from September 2009 to July 2014 were divided into two groups. According to its basic serum thyroid stimulating hormone (TSH) level, it is divided into three groups: TSH0.55,0.55-2.5,2.5mIU/L.. According to the level of serum free triiodothyronine (fT3), it was divided into three groups: fT3 鈮，

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