心力衰竭患者血清甲状腺激素水平变化及临床意义
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摘要
目的探讨心力衰竭患者血清甲状腺激素水平的变化及其临床意义。方法选择2016年2~12月深圳市光明新区人民医院收治的60例心力衰竭患者作为观察组,选择同期因心绞痛、心律失常等住院治疗的55例患者作为对照组,检测各组甲状腺激素水平,比较两组患者之间以及心力衰竭不同心功能分级患者之间三碘原氨酸(T3)、甲状腺素(T4)、游离三碘原氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺激素(TSH)水平的差异。结果观察组患者的T3、T4、FT3、FT4水平分别为(1.57±0.23)μg/L、(98.09±20.46)μg/L、(4.32±0.75)pmol/L、(15.28±0.26)pmol/L,均明显低于对照组的(2.42±0.24)μg/L、(113.3±20.43)μg/L、(6.83±0.77)pmol/L、(20.36±0.28)pmol/L,TSH水平为(16.61±1.57)U/L,明显高于对照组的(6.72±1.58)U/L,差异均有统计学意义(P<0.05);观察组患者随心功能分级的升高,T3、T4、FT3、FT4水平降低,TSH浓度升高,各组间比较差异均具统计学意义(P<0.05)。结论心力衰竭患者存在甲状腺激素代谢紊乱现象,监测甲状腺激素水平变化有利于合理应用药物治疗,改善预后。
Objective To discuss the change of serum thyroid hormone in patients with CHF and its clinical significances. Methods A total of 60 patients with CHF, who admitted to the People's Hospital of Guangming New District of Shenzhen during February 2016 to December 2016 were selected as the observation group, and 55 patients with angina pectoris or arrhythmia were enrolled into the control group. The level of serum thyroid hormone were measured, and the levels of triiodothyronine(T3), thyroxine(T4), free T3(FT3), free T4(FT4), thyrotropin(TSH) in the two groups and heart failure patients with different cardiac function classification were compared. Results The levels of T3, T4, FT3, FT4 in the observation group were(1.57±0.23) μg/L,(98.09±20.46) μg/L,(4.32±0.75) pmol/L,(15.28±0.26) pmol/L, respectively, which were significantly lower than the corresponding(2.42±0.24) μg/L,(113.3±20.43) μg/L,(6.83±0.77) pmol/L,(20.36±0.28) pmol/L in the control group(P<0.05); the level of TSH in the observation group was(16.61±1.57) U/L, which was significantly higher than(6.72±1.58) U/L in the control group(P<0.05). With the increasing of the cardiac function classification, the levels of T3, T4, FT3, FT4 were significantly decreased, and TSH significantly increased in the observation group(P<0.05). Conclusion Thyroid hormone metabolism disorder exists in patients with heart failure. Monitoring the changes of thyroid hormone levels is conducive to the rational use of drug treatment and the improvement of the prognosis.
Objective To discuss the change of serum thyroid hormone in patients with CHF and its clinical significances. Methods A total of 60 patients with CHF, who admitted to the People's Hospital of Guangming New District of Shenzhen during February 2016 to December 2016 were selected as the observation group, and 55 patients with angina pectoris or arrhythmia were enrolled into the control group. The level of serum thyroid hormone were measured, and the levels of triiodothyronine(T3), thyroxine(T4), free T3(FT3), free T4(FT4), thyrotropin(TSH) in the two groups and heart failure patients with different cardiac function classification were compared. Results The levels of T3, T4, FT3, FT4 in the observation group were(1.57±0.23) μg/L,(98.09±20.46) μg/L,(4.32±0.75) pmol/L,(15.28±0.26) pmol/L, respectively, which were significantly lower than the corresponding(2.42±0.24) μg/L,(113.3±20.43) μg/L,(6.83±0.77) pmol/L,(20.36±0.28) pmol/L in the control group(P<0.05); the level of TSH in the observation group was(16.61±1.57) U/L, which was significantly higher than(6.72±1.58) U/L in the control group(P<0.05). With the increasing of the cardiac function classification, the levels of T3, T4, FT3, FT4 were significantly decreased, and TSH significantly increased in the observation group(P<0.05). Conclusion Thyroid hormone metabolism disorder exists in patients with heart failure. Monitoring the changes of thyroid hormone levels is conducive to the rational use of drug treatment and the improvement of the prognosis.
引文
[1]张韵娇,艾力曼·马合木提.慢性心力衰竭与正常甲状腺功能病态综合征的相关性研究进展[J].海南医学,2016,27(7):1126-1128.
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[4]Ponikowski P,Voors AA,Anker SD,et al.2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.The Task Force for the diagnosis and treatment of acute andchronic heart failure of the European Society of Society(ESC),developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].Eur J Heart Fail,2016,18(8):891-975.
[5]Schmidt-Ott UM,Ascheim DD.Thyroid hormone and heart failure[J].Curr Heart Fail Rep,2006,3(3):114-119.
[6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.右心衰竭诊断和治疗中国专家共识[J].中华心血管病杂志,2012,40(6):449-461.
[7]Colzani RM,Emdin M,Conforti F,et al.Hypert hyroidism is associated wit hlengt hening of ventricular repolarization[J].Clin Endocrinol(Oxf),2001,55(1):27-32.
[8]Galli E,Pingitore A,Iervasi G.The role of thyroid hormone in the pathophysiology of heart failure:clinical evidence[J].Heart Fail Rev,2010,15(2):155-169.
[9]吴红花,高燕明.老年病与正常甲状腺病态综合征[J].中华老年多器官疾病杂志,2011,10(6):570-572.
[10]Moruzzi P,Doria E,Agostini PG,et al.Usefulness of I thyroxine to imrove cardiac and exercise performance in idiopathic dilated cardiomyopathy[J].Am J Cardiol,1994,73(5):374-378.
[11]芦广萍,闫爱春,庞学书.慢性心力衰竭合并甲状腺功能病态综合征142例临床分析[J].陕西医学杂志,2007,36(12):1653-1655.
[12]韩海玲,孙玉芹,宋文刚,等.老充血性心力衰竭患者血清甲状腺激素变化特点和左甲状腺素片干预的意义[J].中国老年学杂志,2011,31(1):1974-1976.
[2]贾学元,何恒君.妊娠早期母体TSH水平异常对其妊娠结局的影响[J].海南医学,2012,23(24):64-66.
[3]徐超,郭航远.甲状腺疾病与心脏[J].心血管病学进展,2008,29(6):933-935.
[4]Ponikowski P,Voors AA,Anker SD,et al.2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure.The Task Force for the diagnosis and treatment of acute andchronic heart failure of the European Society of Society(ESC),developed with the special contribution of the Heart Failure Association(HFA)of the ESC[J].Eur J Heart Fail,2016,18(8):891-975.
[5]Schmidt-Ott UM,Ascheim DD.Thyroid hormone and heart failure[J].Curr Heart Fail Rep,2006,3(3):114-119.
[6]中华医学会心血管病学分会,中华心血管病杂志编辑委员会.右心衰竭诊断和治疗中国专家共识[J].中华心血管病杂志,2012,40(6):449-461.
[7]Colzani RM,Emdin M,Conforti F,et al.Hypert hyroidism is associated wit hlengt hening of ventricular repolarization[J].Clin Endocrinol(Oxf),2001,55(1):27-32.
[8]Galli E,Pingitore A,Iervasi G.The role of thyroid hormone in the pathophysiology of heart failure:clinical evidence[J].Heart Fail Rev,2010,15(2):155-169.
[9]吴红花,高燕明.老年病与正常甲状腺病态综合征[J].中华老年多器官疾病杂志,2011,10(6):570-572.
[10]Moruzzi P,Doria E,Agostini PG,et al.Usefulness of I thyroxine to imrove cardiac and exercise performance in idiopathic dilated cardiomyopathy[J].Am J Cardiol,1994,73(5):374-378.
[11]芦广萍,闫爱春,庞学书.慢性心力衰竭合并甲状腺功能病态综合征142例临床分析[J].陕西医学杂志,2007,36(12):1653-1655.
[12]韩海玲,孙玉芹,宋文刚,等.老充血性心力衰竭患者血清甲状腺激素变化特点和左甲状腺素片干预的意义[J].中国老年学杂志,2011,31(1):1974-1976.