游离甲状腺素联合左室射血分数对甲亢性心脏病的评估价值

doi:10.3969/j.issn.1004-583X.2025.10.004

摘要/Abstract

摘要：

目的探讨游离甲状腺素(free thyroxine 4,FT₄)联合左室射血分数(left ventricular ejection fraction,LVEF)对甲状腺功能亢进症(甲亢)患者并发甲亢性心脏病(hyperthyroid heart disease,HHD)的评估价值。方法本研究为回顾性研究,纳入2023年1月-2025年1月于北京市仁和医院心内科门诊及住院部诊断为甲亢或HHD的患者104例,依据是否合并HHD分为甲亢组(n=64)和HHD组(n=40)。比较两组一般资料(性别、年龄、吸烟史)、甲状腺功能指标(游离三碘甲状腺原氨酸、FT₄、促甲状腺激素)及心功能指标(左室舒张末期直径、左室收缩末期直径、LVEF)等的差异;采用多因素logistic回归分析HHD的独立危险因素,通过绘制受试者工作特征曲线分析各指标对HHD的预测效能。结果 HHD组年龄和吸烟史占比均大于甲亢组(P<0.05)。甲亢组游离三碘甲状腺原氨酸水平、FT₄水平、左室舒张末期直径和左室收缩末期直径均低于HHD组(P<0.05),甲亢组促甲状腺激素与LVEF均高于HHD组(P<0.05)。多因素logistic回归分析显示,年龄、吸烟史、FT₃、FT₄、LVESD和LVEDD均为甲亢患者合并HHD的危险因素,TSH和LVEF是其保护性因素,差异有统计学意义(P<0.05)。经受试者工作特征曲线检验,甲状腺功能指标及心功能指标对HHD均具有预测价值(P<0.05)。FT₄联合LVEF指标的评估价值更高,其曲线下面积为0.98,特异度为64.06%,敏感度为51.82%(P<0.001)。结论 FT₄和LVEF对甲亢并发HHD有一定的评估价值,且FT₄联合LVEF的预测价值更高,可作为临床预测甲亢并发HHD的重要参考指标。

关键词: 甲状腺功能亢进症, 甲亢性心脏病, 危险因素, 相关性分析

Abstract:

Objective To evaluate the diagnostic value of free thyroxine (FT₄) combined with left ventricular ejection fraction (LVEF) for hyperthyroid heart disease (HHD) in patients with hyperthyroidism. Methods This retrospective study included 104 consecutive patients diagnosed with hyperthyroidism or HHD who were evaluated in the Cardiology Department (outpatient and inpatient) of Beijing Renhe Hospital from January 2023 to January 2025. Based on the presence of HHD, patients were classified into the hyperthyroidism-only group (n=64) and HHD group (n=40). The demographics (sex, age, smoking history), thyroid function indices (free triiodothyronine [FT₃], FT₄, thyroid-stimulating hormone [TSH]), and echocardiographic indices (left ventricular end-diastolic diameter [LVEDD], left ventricular end-systolic diameter [LVESD], and LVEF) between groups were compared. Multivariable logistic regression was used to analyze the independent factors associated with HHD. Receiver operating characteristic (ROC) curves were drawn to analyze the discriminative performance of individual indices and the FT₄+LVEF combination. Results Patients with HHD were older and more likely to have a history of smoking than those with hyperthyroidism alone (P<0.05). Compared with the hyperthyroidism-only group, the HHD group had significantly higher FT₃, FT₄, LVEDD, and LVESD, and lower TSH and LVEF (all P<0.05). Multivariable logistic regression analysis showed that age, smoking history, FT₃, FT₄, LVESD and LVEDD were risk factors for HHD, while LVEF and TSH were protective factors (all P<0.05). ROC analysis showed that both thyroid and cardiac indices had significant predictive value for HHD (P<0.05). The combination of FT₄ and LVEF provided the highest overall performance (area under the curve [AUC]=0.98), with a specificity of 64.06%, and a sensitivity of 51.82%(P<0.001). Conclusion FT₄ and LVEF each have clinical value in evaluating hyperthyroidism complicated by HHD. Their combination improves discrimination and can serve as an important reference for clinical decision-making.

Key words: hyperthyroidism, hyperthyroid heart disease, risk factors, correlation analysis

中图分类号:

R581.1

刘胜华. 游离甲状腺素联合左室射血分数对甲亢性心脏病的评估价值[J]. 临床荟萃, 2025, 40(10): 897-903.

Liu Shenghua. Assessment value of FT₄ combined with LVEF in hyperthyroid heart disease[J]. Clinical Focus, 2025, 40(10): 897-903.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.10.004

https://www.lchc.cn/CN/Y2025/V40/I10/897

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参考文献 38

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典型症状群	高代谢症候群:体重进行性下降、怕热多汗、食欲亢进
	神经兴奋性增加:手颤、失眠、易激惹等
影像学证据	甲状腺肿大
实验室指标	血清甲状腺激素水平上升、促甲状腺激素(thyroid stimulating hormone,TSH)降低

典型症状群	高代谢症候群:体重进行性下降、怕热多汗、食欲亢进
	神经兴奋性增加:手颤、失眠、易激惹等
影像学证据	甲状腺肿大
实验室指标	血清甲状腺激素水平上升、促甲状腺激素(thyroid stimulating hormone,TSH)降低

必要条件	确诊甲亢
次要条件	①明显的房性心律失常:房性心动过速、心房扑动、心房颤动;②心力衰竭;③心脏扩大
排除条件	其他原因导致的心脏疾病

必要条件	确诊甲亢
次要条件	①明显的房性心律失常:房性心动过速、心房扑动、心房颤动;②心力衰竭;③心脏扩大
排除条件	其他原因导致的心脏疾病

组别	例数	女性 [例(%)]	年龄 (岁)	吸烟史 [例(%)]
甲亢组	64	35(54.69)	34.78±8.37	8(12.50)
HHD组	40	22(55.00)	40.13±10.61	16(40.00)
t/χ²值		0.001	2.853	10.490
P值		0.975	0.005	0.001