甲状腺激素对心脏自主神经和心室复极动态性的影响  

The effects of thyroid hormone on cardiac autonomic tone and ventricular repolarization dynamicity

作　　者：钟慧[1] 包明威[1] 张逸杰[1] 谭团团[1] 

机构地区：[1]武汉大学人民医院心内科,430060

出　　处：《临床内科杂志》2014年第6期379-381,共3页Journal of Clinical Internal Medicine

基　　金：国家自然科学基金资助项目（30600241）

摘　　要：目的 评估甲状腺激素对心脏自主神经功能和心室复极动态性的影响.方法 选取甲状腺功能亢进患者57例和健康体检者55例.所有入选对象询问病史、体格检查以及血液甲状腺激素、体表心电图和动态心电图检查.检测以下指标：游离三碘甲状腺素原氨酸（FT3）、游离甲状腺素（FT4）、促甲状腺素（TSH）、总频（TP）、极低频（VLF）、低频（LF）、高频（HF）、LF/HF比值、所有窦性心搏RR间期标准差（SDNN）、全程相邻RR间期差值的平方根（RMSSD）、全程记录中每5分钟RR间期平均值的标准差（SDANN）、相邻RR间期差≥50 ms的个数占总心跳数的百分比（PNN50％）、QT间期离散度（QTd）、QRS宽度、心率矫正的QT间期（QTc）、QTe/RR斜率（QTe为Q波起始至T波终点的间期）和QTp/RR斜率（QTp为Q波起始至T波顶点的间期）.结果 甲亢组FT3、FT4、TSH、QTd、VLF、LF、HF、TP、SDNN、PNN50、QTe/RR和QTp/RR斜率指标治疗前与对照组比较差异有统计学意义（P＜0.05）;甲亢组FT3、FT3、TSH、QTd、VLF、LF、HF、TP、LF/HF、SDNN、SDANN、PNN50％、QTe/RR斜率和QTp/RR斜率指标治疗前与治疗后比较差异有统计学意义（P＜0.05）;甲亢组治疗后上述相关指标与对照组比较差异无统计学意义（P＞0.05）.结论 甲状腺激素除了影响窦房结功能,表现为心率增快和心率变异性异常外,同时也影响心室的复极动态性,表现为QT/RR斜率的增大.Objective To investigate the effects of thyroid hormone on cardiac autonomic nervous tone and ventricular repolarization dynamicity.Methods 57 hyperthyroidism patients and 55 healthy volunteers were enrolled.All subjects underwent physical examination,blood thyroid hormone testing,cardiac ultrasound,electrocardiogram and 24h ambulatory electrocardiography at enrollment.Following index were studied：serum triiodothyronine （FT3）,free thyroxine （FT4）,thyrotropin （TSH）,all frequency power （TP）,very low frequency power （VLF）,low frequency power （LF）,high frequency power （HF）,LF/HFratio （LF/HF）,standard deviation of normal to normal intervals （SDNN）,rate mean square of the differences of successive RR Intervals （RMSSD）,the standard deviation of the nNormal RR intervals means every 5 minutes in a time interval（SDANN）,the percentage of RR intervals differing ＞50 ms（PNNS0％）,QT interval dispersion （QTd）,QT corrected for heart rate （QTc）,width of QRS complex,QTe/RR （QTe is Q wave starting to T wave end of interphase） and QTp/RR slope（QTp is Q wave starting to T wave peak of interphase）.Results FT3,FT4,TSH,QTd,VLF,LF,HF,TP,SDNN,PNN50,QTe/RR and QTp/RR slope shown significant difference between hyperthyroid group and control group（P ＜ 0.05）.FT3,FT4,TSH,QTd,VLF,LF,HF,TP,LF/HF,SDNN,SDANN,PNN50％,QTe/RR and QTp/RR slope shown significant difference between hyperthyroidism patients before and after treatment （P ＜ 0.05）.The index shown no difference between hyperthyroidism patients treatmened and control group （P ＞ 0.05）.Conclusion As well as affect sino-atrial node,increase heart rate and lead to abnormal HRV,thyroid hormone also affect ventricular reporlarization dynamicity and increase the QT/RR slope.

关 键 词：甲状腺功能亢进 心率变异性 复极 

分 类 号：R587.1[医药卫生—内分泌]