甲状腺激素水平对左心室舒张功能障碍患者的早期诊断价值  

The Early Diagnostic Value of Thyroid Hormone Level in Patients With Left Ventricular Diastolic Dysfunction

作　　者：高嵩[1] 严洁[1] 张锋[1] 吴丁烨[1] 张煜[1] 

机构地区：[1]南京医科大学附属无锡市人民医院重症医学科,江苏省无锡市214023

出　　处：《中国循环杂志》2015年第2期140-143,共4页Chinese Circulation Journal

摘　　要：目的:探讨甲状腺激素水平对左心室舒张功能障碍患者的早期诊断价值。方法:选择2013-01至2014-01我院门诊及住院部确诊为心功能不全患者共121例,根据组织多普勒及血流多普勒结果,参照2007年欧洲心脏病学会(ESC)专家共识将其分为左心室舒张功能受损组40例、左心室舒张功能衰竭组41例、左心室收缩功能障碍组40例。另选择同期来我院体检证实无疾病的健康人群为正常对照组共40例。主要检测指标包括左心室舒张早期二尖瓣血流峰值速度(E值)、二尖瓣环左侧壁附着处心肌舒张早期运动峰值(Em)、E/Em值、N末端B型利钠肽原(NT-pro BNP)、游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)、反三碘甲腺原氨酸(r T3)生化值。结果:FT3值、rT 3值在四组之间两两比较差异均有统计学意义(P<0.05),FT4及NT-proB NP值在四组间两两比较除正常对照组与左心室舒张功能受损组差异无统计学意义外,其余各组差异均有统计学意义(P<0.05)。TSH在四组间比较差异均无统计学意义(P>0.05)。E/Em值与FT3值存在负相关性(r=-0.724,P<0.05)。E/Em值与FT4值存在负相关性(r=-0.49,P<0.05)。E/Em与rT 3值间存在正相关性(r=0.87,P<0.05)。E/Em与NT-proB NP值存在正相关性(r=0.83,P<0.05)。结论:心脏舒张功能障碍患者可能已出现甲状腺激素水平变化;且甲状腺激素水平可能随着心脏功能受损的严重程度而改变。NT-proB NP联合甲状腺激素水平可作为舒张性心功能不全早期诊断的参考指标。Objective： To explore the early diaghostic value of thyroid hormone level in patients with left ventricular diastolic dysfunction. Methods： Our work included 4 groups：①Normal control group, n=40,②Impaired left ventricular diastolic function group, n=40,③Failure of left ventricular diastolic function group, n=41 and④Impaired left ventricular systolic function group, n=40. The cardiac function was assessed by color Doppler lfow imaging and tissue Doppler imaging for the early diastolic mitral lfow velocity （E）, the peak early diastolic mitral annular velocity （Em） and the ratio of E/Em. The blood levels of NT-proBNP and FT3, FT4, TSH, rT3 were examined in clinical laboratory. Results： Blood levels of FT3 and rT3 were different in pair wise comparison among 4 groups, P〈0.05, and FT4 and NT-proBNP were different in pair wise comparison among 4 groups, except for Normal control group and Impaired left ventricular diastolic function group, P〈0.05. The TSH level was similar among 4 groups, P〉0.05. The ratio of E/Em was negatively related to FT3 （r=-0.724, P〈0.05） and FT4 （r=-0.49, P〈0.05）, while positively related to rT3 （r=0.87, P〈0.05） and NT-proBNP （r=0.83, P〈0.05）. Conclusion： The changes of thyroid hormone level may exist in patients with impaired diastolic function and it may vary with the severity of the cardiac dysfunction. Blood levels of NT-proBNP with thyroid hormone might be used as a reference index for early diagnosis of diastolic dysfunction.

关 键 词：甲状腺激素 心脏舒张功能 组织多普勒 N末端B型利钠肽原 反三碘甲腺原氨酸 

分 类 号：R54[医药卫生—心血管疾病]