亚临床甲状腺功能减退对慢性心力衰竭患者心功能的影响  

The effects of subclinical hypothyroidism on cardiac function in patients with heart failure

作　　者：王文志[1,2] 马玉梅[3] 张梅[2] WANG Wen-zhi MA Yu-mei ZHANG Mei(Graduate School of Tianjin Medical University, Tianjin 300070, Chin)

机构地区：[1]天津医科大学研究生院,天津300070 [2]武警后勤学院附属医院心内科 [3]兰州大学第二医院心外科重症监护病房

出　　处：《中国慢性病预防与控制》2017年第7期502-506,共5页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：天津市科委应用基础与前沿技术研究计划重点项目(16JCZDJC31900)

摘　　要：目的探讨慢性心力衰竭(CHF)患者亚临床甲状腺功能减退(简称"亚临床甲减")对心功能的影响,为CHF的治疗提供新思路。方法选取2010年1月至2016年10月于武警后勤学院附属医院心内科住院的344例CHF患者为研究对象。其中,CHF合并甲状腺功能正常组233例,CHF合并亚临床甲减组111例。根据患者的血清促甲状腺素(TSH)水平,将亚临床甲减组再分为轻度亚临床甲减组(74例,TSH:4.6~9.9 mIU/L)和重度亚临床甲减组(37例,TSH≥10 mIU/L)。对两组患者进行生化指标测定和心脏彩超检测。用SPSS 17.0软件进行t检验、单因素方差分析、秩和检验和χ~2检验,用Spearman相关进行相关性分析。结果甲状腺功能正常组的白细胞、红细胞、血红蛋白水平高于轻度、重度亚临床甲减组,差异均有统计学意义(P<0.05,P<0.01)。Spearman相关性分析结果显示,红细胞与TSH水平呈负相关(r=-0.310,P<0.01),血红蛋白含量与TSH水平呈负相关(r=-0.316,P<0.01)。甲状腺功能正常组E峰流速(89 cm/s,P25~P75:76~102 cm/s)明显低于轻度、重度亚临床甲减组(分别为93 cm/s,P25~P75:83~106 cm/s和98 cm/s,P25~P75:84~114 cm/s),差异均有统计学意义(P<0.01);且E峰随着TSH的升高而升高,两者呈正相关(r=0.149,P<0.05)。结论 CHF患者亚临床甲减水平与贫血具有一定相关性,CHF患者亚临床甲减与心脏舒张功能降低密切相关。Objective To explore the effects of subclinical hypothyroidism on cardiac function in patients with chronic heart failure（CHF） and to provide the new idea for treating CHF. Methods The subjects were 344 CHF patients hospitalized in hospital from January of 2010 to October of 2016, 233 subjects were the CHF patients with normal thyroid function, 111 subjects were the CHF patients with subclinical hypothyroidism. According to TSH level, the subclinical hypothyroidism group was divided into mild subclinical hypothyroidism sub-group（74 cases, TSH： 4.6-9.9 mIU/L） and severe subclinical hypothyroidism sub-group（37 cases,TSH： ≥10 mIU/L）. The biochemical indexes（TSH, FT3, FT4, triglycerides, total cholesterol, LDL-C, HDL-C, NT-pro-BNP） and echocardiography were detected for two groups. The t test and χ~2test were used to analyze the data with SPSS 17.0 software.Spearman correlation analysis also was used. Results The levels of leukocyte, red cell, hemoglobin in normal thyroid function group were significantly higher than those in two subclinical hypothyroidism sub-groups（P〈0.05 or P〈0.01）. Spearman correlation analysis showed that RBC was negatively correlated with TSH level（r=-0.310, P〈0.01）, hemoglobin was negatively correlated with TSH level（r=-0.316, P〈0.01）. The peak E velocity of normal thyroid function group was significantly lower than those of two subclinical hypothyroidism sub-groups（P〈0.01）, and the peak E velocity increased with TSH level, there was positive correlation（r =0.149,P〈0.05）. Conclusion In CHF patients, the subclinical hypothyroidism is correlated with anemia, subclinical hypothyroidism is closely associated with decreased cardiac diastolic function in patients with chronic heart failure.

关 键 词：慢性心力衰竭 亚临床甲状腺功能减退 心脏舒张功能 E峰 

分 类 号：R581.2[医药卫生—内分泌]