Abstract:

Objective　To observe the influence of abnormal thyroid function on the severity of ICU patients with coronary heart disease and its correlation with the number of coronary artery lesions. Methods　A retrospective study was conducted on 113 patients with coronary heart disease who were admitted to ICU, First Hospital, Nanyang Medical College from January 2021 to June 2022. According to the results of thyroid function examination, 43 patients with normal thyroid function were classified as a normal group, 35 patients with hyperthyroidism as a hyperthyroidism group, and the remaining 35 patients with hypothyroidism as a hypothyroidism group. The disease incidences, Gensini scores of coronary artery disease, and the proportions of the patients with different severity of coronary heart disease were compared between the three groups. The receiver operator characteristic curve (ROC) was drawn to validate thyroid function as the disease severity predictor. According to the numbers of lesions, the patients with only 1 lesion branch were classified as group A, the patients with 2 lesion branches as group B, and the patients with 3 lesion branches as group C; the thyroid function test results were compared between the three groups. The Spearman correlation coefficient was used to verify the correlation between thyroid function and lesion numbers. χ², t, and F tests were used. Results　The score of Visual Analogue Scale (VAS), the frequency of attacks, the duration of pain, the degree of coronary stenosis, and the Gensini score of the hypothyroidism group were (5.25±1.41), (4.14±1.25) times/day, (5.41±1.38) min, (68.12±10.46)%, and (35.25±5.47), which were higher than those in the hyperthyroidism group [(4.12±1.35), (3.04±0.13) times/day, (4.29±0.73) min, (60.21±10.44)%, and (32.44±5.48)] and those in the normal group [(3.92±0.48), (2.23±0.45) times/day, (3.11±0.46) min, (53.77±10.63)%, and (28.35±5.25)], with statistical differences (F=14.98, 62.28, 61.50, 17.95, and 16.22; all P<0.05). The proportion of the patients with severe coronary heart disease in the hypothyroidism group was 68.57% (24/35), which was higher than those in the hyperthyroidism group [34.29% (12/35)] and the normal group [23.26% (10/43)], with a statistical difference (χ²=45.825,P<0.05). The ROC showed that as the TSH level increased, the T3 and T4 levels decreased, and conditions of the ICU patients with coronary heart disease gradually worsened. The TSH level in group C was (8.27 ± 2.33) mU/L, which was higher than those in group B [(6.62±2.33) mU/L] and group A [(4.41±1.28) mU/L]; the T3 and T4 levels in group C were (0.72±0.11) nmol/L and (3.71±0.37) μg/dL, which were lower than those in group B [(1.25±0.36) nmol/L and (5.15±1.88) μg/dL] and group A [(2.05±0.41) nmol/L and (7.44±2.12) μg/dL]; there were statistical differences (F=30.48, 155.25, and 46.43; all P<0.05). The Spearman correlation coefficient test showed that the number of coronary lesion branches in the ICU patients with coronary heart disease increased with the TSH level and as the T3 and T4 levels decreased. Conclusions　Hypothyroidism can exacerbate the severity in ICU patients with coronary heart disease; the TSH level is positively correlated with the number of lesions, while the T3 and T4 levels negatively with the number of lesions.

Key words:

Coronary heart disease, Severity of conditions, Thyroid function, Number of lesion branches, Correlation analysis

摘要：

目的　观察甲状腺功能异常对重症监护室（ICU）冠心病患者病情严重程度的影响及与冠脉病变支数的相关性。方法　本研究以2021年1月至2022年6月期间进入南阳医学高等专科学校第一附属医院ICU接受治疗的113例冠心病患者为研究对象，开展回顾性研究，根据甲状腺功能检查结果，将43例甲状腺功能正常的患者列为正常组，将35例甲状腺功能亢进的患者列为甲亢组，其余35例甲状腺功能减退的患者列为甲减组，记录并对比3组患者的病情发作情况，以及冠脉病变Gensini评分结果，统计并对比3组冠心病不同严重程度占比，通过绘制受试者工作特征曲线（ROC）验证甲状腺功能对病情严重程度的预测效能；根据病变支数不同，将仅有1支病变患者列为A组，2支病变患者列为B组，3支病变患者列为C组，比较3组患者的甲状腺功能检查结果，通过Spearman相关性系数验证甲状腺功能与病变支数的关联。统计学方法采用χ²检验、t检验、F检验。结果　经统计，甲减组的视觉模拟量表（VAS）评分、发作频率、疼痛持续时间、冠脉狭窄程度、Gensini评分分别为（5.25±1.41）分、（4.14±1.25）次/d、（5.41±1.38）min、（68.12±10.46）%、（35.25±5.47）分，均高于甲亢组［（4.12±1.35）分、（3.04±0.13）次/d、（4.29±0.73）min、（60.21±10.44）%、（32.44±5.48）分］、正常组［（3.92±0.48）分、（2.23±0.45）次/d、（3.11±0.46）min、（53.77±10.63）%、（28.35±5.25）分］，差异均有统计学意义（F=14.98、62.28、61.50、17.95、16.22，均P<0.05）。甲减组的重度冠心病占比为68.57%（24/35），高于甲亢组［34.29%（12/35）］、正常组［23.26%（10/43）］，差异有统计学意义（χ²=45.825，P<0.05）。ROC显示，随促甲状腺激素（TSH）水平升高，三碘甲状腺原氨酸（T3）、四碘甲状腺原氨酸（T4）水平下降，ICU冠心病患者病情会逐步加重。经检查，C组患者的TSH水平为（8.27±2.33）mU/L，高于B组［（6.62±2.33）mU/L］、A组［（4.41±1.28）mU/L］；C组T3为（0.72±0.11）nmol/L，T4为（3.71±0.37）μg/dl，低于B组［（1.25±0.36）nmol/L、（5.15±1.88）μg/dl］、A组［（2.05±0.41）nmol/L、（7.44±2.12）μg/dl］，差异均有统计学意义（F=30.48、155.25、46.43，均P<0.05）。经Spearman相关性系数检验，ICU冠心病患者的冠脉病变支数会随TSH水平升高，T3、T4水平降低而增加。结论　甲状腺功能减退会加重ICU患者病情严重程度，TSH水平与病变支数正相关，T3、T4与病变支数负相关。

关键词:

冠心病, 病情严重程度, 甲状腺功能, 病变支数, 相关性分析