重症慢性充血性心力衰竭患者甲状腺素水平及小剂量左旋甲状腺素治疗的临床观察  

Study the Serum Levels of Thyroid Hormone on Patients with Chronic Severe CHF and the Efficacy of Thyroid Hormone Treatment

作　　者：王璐璐[1] 黄宜杰 刘奕[1] 付强 蒋树中 

机构地区：[1]江苏省徐州市中心医院,江苏徐州221009 [2]江苏省徐州市心血管病研究所,江苏徐州221009

出　　处：《河北医学》2005年第12期1059-1062,共4页Hebei Medicine

摘　　要：目的:探讨慢性充血性心力衰竭(CHF)患者的血浆甲状腺素水平变化及小剂量左旋甲状腺素(L-TH)治疗的疗效.方法:158例CHF患者根据超声心动图测定的LVEF分为A组72例(LVEF≥40%),B组86例(LVEF<40%),再将B组分为L-TH治疗组32例和对照组54例.A、B两组均常规给予抗心衰药物治疗,唯治疗组加用L-TH25～50ug/d,疗程4周.治疗前后检测血浆TH、临床心功能、超声心动图.结果:①血浆TH水平:治疗前A、B两组FT3、FT4水平均低于正常值,B组较A组差异有显著性(P<0.01、P<0.05),TSH值组间无显著差异(P>0.05、P>0.05).治疗后治疗组FT3、FT4水平均有显著升高(P<0.01、P<0.05),TSH变化无显著差异(P>0.05).②心功能改变:治疗组临床心功能改善1～2级,治疗组左室舒张末期内径缩小,LVEF增加,与治疗前比P<0.01,与对照组比P<0.05.结论:慢性充血性心力衰竭患者FT3、FT4水平降低,经小剂量L-TH治疗,疗效显著,未发现明显不良反应.Objective： To study the relationship between the serum levels of thyroid hormone and the degree of the congestive heart failure as well as the effects of thyroxine on patients with chronic severe congestive heart failure （CHF）. Methods： 158 cases were divided into group A（72 cases of LVEF≥40% ） and group B （86 cases of LVEF 〈40%）. The group B was divided into the observation group （ 32 cases ） and the control group （ 54 cases ）. All patients were treated with conventional methods and thyroxine 25-50ug every day was added in the observation group for 4 weeks. The serum FT3 , FT4 ,TSH, heart function and echocardiography were examined before and after treatment. Results：①Both group A and B had lower base line serum FT3 and FT4 ,which were significantly lower in the group B than those in group A （p〈0.01, p〈0.05） . The levels of TSH were normal （p〉0.05）. After 4 weeks of treatment in the observation group , FT3 and FT4 increased . TSH had no significant difference （p〉0.05）.② After treatment in the observation group , the clinical heart function improved by 1-2 grades , the left ventricular and diastoleinternal diameter decreased and the ejection fraction of left ventricular increased , the difference was significant , p〈0.01. Compared with the control group , the above parameters also had significant difference, p〈0.05. Conclusion： This study indicates that the levels of serum FT3, FT4 are lower in patients with chronic congestive heart failure and small dose of thyroid hormone treatment is safe and beneficial.

关 键 词：心力衰竭 充血性 甲状腺激素类 

分 类 号：R541.61[医药卫生—心血管疾病]