小剂量甲状腺素治疗老年难治性心衰合并正常甲状腺病态综合征  

Therapeutic effect of low-dose thyroxin in elderly patients with refractory heart failure and euthyroid sick syndrome

作　　者：刘泽[1] 吴军[1] 张源源[1] 冯德光[1] 刘玲[1] 孙杰[2] 彭艳[2] 郭振辉[2] 

机构地区：[1]广州军区广州总医院干部病房五科,广东广州510010 [2]广州军区广州总医院MICU科,广东广州510010

出　　处：《南方医科大学学报》2009年第9期1848-1850,共3页Journal of Southern Medical University

基　　金：广州市科委攻关计划项目(2007z3-E0121)

摘　　要：目的探讨在常规抗心衰治疗的基础上加用小剂量左甲状腺素片治疗老年难治性心力衰竭(RHF)并正常甲状腺病态综合征(ESS)患者的临床疗效。方法RHF并ESS的老年患者54例随机分为常规抗心衰治疗组(A组,n=32)以及在常规抗心衰治疗的基础上加用口服左甲状腺素片治疗组(B组,n=22),左甲状腺素片口服剂量为6.25～25μg/d。治疗1个月后,比较2组治疗前后的血浆BNP水平、心脏超声心动图测量的左室射血分数(LVEF)以及心功能NYHA分级的变化。结果A组患者治疗期间5例死于严重心律失常,其余27例患者治疗前后血浆BNP水平、LVEF值以及NYHA均未见明显改善(P>0.01)。B组患者治疗期间无发生死亡或严重心律失常,血浆BNP水平、LVEF值及NYHA分级均明显改善(P<0.01),治疗期间无发生甲状腺功能亢进。结论针对老年RHF并ESS患者,在常规抗心衰治疗的基础上加用甲状腺素治疗,可显著提高疗效。Objective To investigate the therapeutic effect of low-dose thyroxin in eldedy patients with refractory heart failure （RHF） and euthyroid sick syndrome （ESS）. Methods Fifty-four elderly patients with RHF and ESS were randomized into conventional treatment group （n=32） and L-thyroxine group with additional oral L-thyroxine at the daily dose of 6.25-25μg （n=22）. The changes in the plasma levels of brain natriuretic peptides （BNP）, left ventricular ejection fraction （LVEF）, and cardiac function （NYHA level） of the two groups were compared after 1 month of treatment. Results Five patients receiving conventional treatment died due to severe arrhythmia during the treatment, and in the other 27 patients, the levels of plasma BNP, LVEF, and cardiac function showed no significant improvements after 1 month of treatment （P〉0.01）. In L-thyroxine group, no death or severe arrhythmia occurred, and the levels of plasma BNP, LVEF, and cardiac function were significantly improved after the treatment （P〈0.01）. No thyrotoxicosis occurred during the administration of L-thyroxine in the latter group. Conclusion Low-dose L-thyroxine in addition to the conventional treatments may enhance the therapeutic effect in elderly patients with RHF and ESS.

关 键 词：甲状腺素 老年人 难治性心力衰竭 正常甲状腺病态综合征 脑钠肽 

分 类 号：R541.6[医药卫生—心血管疾病]