小剂量左旋甲状腺素对伴低T3综合征的慢性充血性心力衰竭患者心功能的影响  

Effects of low dose of levothyroxine on heart function in patients with congestive heart failure and low T3 syndrome

作　　者：冯燕玲 黄冰生 李劲草 张鹏 

机构地区：[1]广州市番禺区何贤纪念医院心内科,511400

出　　处：《国际心血管病杂志》2014年第2期127-130,共4页International Journal of Cardiovascular Disease

摘　　要：目的:评估小剂量补充左旋甲状腺素对伴低T3综合征的慢性充血性心力衰竭(CHF)患者的影响。方法:选择2010年1月至2012年1月在我院心内科住院确诊伴低T3综合征的CHF患者100例,随机平均分为2组:对照组常规抗心力衰竭药物治疗;治疗组在常规抗心力衰竭药物基础上每日口服1次左旋甲状腺素钠片25μg。随访期6个月,所有研究对象在研究初始及随访结束时均行甲状腺功能包括游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素释放激素(TSH)、甲状腺彩超、B型利钠肽(BNP)、基质金属蛋白酶(MMP)-9水平及左室质量指数(LVMI)检测,并记录两组患者心血管事件及不良反应的发生率。结果:与对照组比较,治疗组BNP、MMP-9水平明显降低,FT3水平升高(P<0.05)。治疗组患者LVMI及心血管事件发生率较对照组无显著性差异;治疗组无明显不良反应发生。结论:对CHF伴低T3综合征的患者,加用小剂量左旋甲状腺素钠治疗,无明显不良反应,并可明显降低患者血清BNP及MMP-9水平。Objective：To investigate the effects of low dose of levothyroxine on heart function in patients with congestive heart failure （CHF） and low T3 syndrome. Methods： A cohort of 100 CHF patients complicated with low T3 syndrome were randomly divided into two groups： general therapy group（group 1, n = 50） and low dose levothyroxine therapy group （group 2, n = 50）. All patients were followed up for 6 months. The thyroid function（FT3, FT4 and TSH）, thyroid ultrasound, the levels of serum B-type natriuretic peptide（BNP）, matrix metalloproteinase-9 （MMP-9） and left ventricular mass index （LVMI） were examined at baseline and 6 months. The rates of cardiovascular events and adverse effects in both groups were recorded. Results：At the end of this study, serum levels of BNP and MMP- 9 were significantly decreased, and serum levels of FT3 were significantly increased in group 2 compared with group 1 （P^0.05）. There were no significant differences between the two groups in LVMI and the rates of cardiovascular events. The adverse effects were not observed in group 2. Conclusion：Low dose of levothyroxine sodium salt might significantly decrease the serum levels of BNP and MMP 9, without causeing safety problems.

关 键 词：小剂量左旋甲状腺素钠 慢性充血性心力衰竭 B型利钠肽 基质金属蛋白酶 左室质量指数 

分 类 号：R541.61[医药卫生—心血管疾病]