体外循环心脏手术对10kg以下婴幼儿甲状腺激素的影响
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摘要
目的观察低体重婴幼儿体外循环心脏手术围手术期甲状腺激素的变化及其规律,探讨体外循环心脏手术对婴幼儿甲状腺激素代谢的影响。
方法选择21例10kg以下行体外循环心室间隔缺损修补术的患儿。分别采取其体外循环前、体外循环结束后、术后第一天、术后第二天和术后第四天的静脉血样,应用微粒子酶联免疫法检测血清中的三碘甲状腺原氨酸(T3)、甲状腺素(T4)和促甲状腺激素(TSH)浓度。
结果T3浓度在体外循环后明显下降,由1.05±0.35ng/ml降至0.83±0.19ng/ml,与体外循环前比较下降了21%,随后继续下降,术后第一天下降49%,术后第二天降至最低点0.41±0.13ng/ml,下降了61%,随后开始恢复,直至术后第四天仍未能恢复至体外循环前水平,较体外循环前下降21%;T4浓度在体外循环结束后及术后第一天未见明显下降,第二天出现明显下降,由7.65±1.73ug/dl降至5.81±1.30ug/dl,第四天恢复至体外循环前水平;TSH浓度体外循环后未发生下降,反而稍有上升,术后第一和第二天出现明显下降,由1.71±1.34uIU/L降至0.38±0.24uIU/L和0.57±0.54uIU/L,分别下降了78%和66%,第四天恢复至体外循环前水平。
结论小儿体外循环心脏手术是发生正常甲状腺病态综合征的明确风险因素,特别是低体重婴幼儿。10kg以下婴幼儿在体外循环心脏手术围手术期会发生2型正常甲状腺病态综合征,表现为不同时刻出现T3、T4和TSH浓度的下降。体外循环心脏手术对小儿,特别是低体重婴幼儿的甲状腺激素水平和功能有重要影响,围手术期加强对患儿甲状腺激素浓度的监测及术后早期补充甲状腺激素有重要意义。
Objective: To observe the tendency and law of thyroid hormone perioperatively, and explore the effects of ECC on thyroid hormone metabolism in low weight infants undergoing ECC surgeries.
Methods: 21 infants weighting less than 10kg undergoing ventricular septal defect(VSD) repair surgeries on ECC was investigated. The venous blood samples were collected at five time points: before ECC, after ECC, 1 day, 2 day, and 4 day post-operatively. The concentration of serum thyroid hormone triiodothyronine(T3), tetraiodothyronine(T4) and thyroid stimulating hormone(TSH) ware assayed by Microparticle Enzyme Immunoassay (MEIA).
Results: The concentration of T3 decreased significantly after ECC, from 1.05±0.35ng/ml to 0.83±0.19ng/ml, which was 21% less than that before ECC, and went on decreasing by 49% on the first day post-operatively and 61% on the second day post-operatively to 0.83±0.19ng/ml, which reached the lowest point. Then it began to recovery, but didn't reach the level before ECC yet, 21% lower than that before ECC; The concentration of T4 didn't decrease obviously after ECC and the first day post-operatively, but decreased from 7.65±1.73ug/dl to 5.81±1.30ug/dl on the second day after ECC, and recovered to the level before ECC on the fourth day. The concentration of TSH increased rather than decreased after ECC, but decreased obviously on the first and second day after operation, from 1.71±1.34uIU/L to 0.38±0.24uIU/L and 0.57±0.54uIU/L, which was 78% and 66% lower. Then it recovered to the level before ECC on the fourth day.
Conclusion: ECC surgery in infants is a definite risk factor related to Euthyroid Sick Syndrome, especially for low birth weight infants. Infants weighting less than 10kg undergoing ECC surgeories could develop type II Euthyroid Sick Syndrome perioperatively and the concentrations of T3, T4 and TSH decreases at different time points. ECC surgery has great effects on the level and function of thyroid hormone of infants, especially for low birth weight infants, so it makes great sense to monitor the thyroid hormone level of the infants perioperatively and supplement thyroid hormone early after surgery.
方法选择21例10kg以下行体外循环心室间隔缺损修补术的患儿。分别采取其体外循环前、体外循环结束后、术后第一天、术后第二天和术后第四天的静脉血样,应用微粒子酶联免疫法检测血清中的三碘甲状腺原氨酸(T3)、甲状腺素(T4)和促甲状腺激素(TSH)浓度。
结果T3浓度在体外循环后明显下降,由1.05±0.35ng/ml降至0.83±0.19ng/ml,与体外循环前比较下降了21%,随后继续下降,术后第一天下降49%,术后第二天降至最低点0.41±0.13ng/ml,下降了61%,随后开始恢复,直至术后第四天仍未能恢复至体外循环前水平,较体外循环前下降21%;T4浓度在体外循环结束后及术后第一天未见明显下降,第二天出现明显下降,由7.65±1.73ug/dl降至5.81±1.30ug/dl,第四天恢复至体外循环前水平;TSH浓度体外循环后未发生下降,反而稍有上升,术后第一和第二天出现明显下降,由1.71±1.34uIU/L降至0.38±0.24uIU/L和0.57±0.54uIU/L,分别下降了78%和66%,第四天恢复至体外循环前水平。
结论小儿体外循环心脏手术是发生正常甲状腺病态综合征的明确风险因素,特别是低体重婴幼儿。10kg以下婴幼儿在体外循环心脏手术围手术期会发生2型正常甲状腺病态综合征,表现为不同时刻出现T3、T4和TSH浓度的下降。体外循环心脏手术对小儿,特别是低体重婴幼儿的甲状腺激素水平和功能有重要影响,围手术期加强对患儿甲状腺激素浓度的监测及术后早期补充甲状腺激素有重要意义。
Objective: To observe the tendency and law of thyroid hormone perioperatively, and explore the effects of ECC on thyroid hormone metabolism in low weight infants undergoing ECC surgeries.
Methods: 21 infants weighting less than 10kg undergoing ventricular septal defect(VSD) repair surgeries on ECC was investigated. The venous blood samples were collected at five time points: before ECC, after ECC, 1 day, 2 day, and 4 day post-operatively. The concentration of serum thyroid hormone triiodothyronine(T3), tetraiodothyronine(T4) and thyroid stimulating hormone(TSH) ware assayed by Microparticle Enzyme Immunoassay (MEIA).
Results: The concentration of T3 decreased significantly after ECC, from 1.05±0.35ng/ml to 0.83±0.19ng/ml, which was 21% less than that before ECC, and went on decreasing by 49% on the first day post-operatively and 61% on the second day post-operatively to 0.83±0.19ng/ml, which reached the lowest point. Then it began to recovery, but didn't reach the level before ECC yet, 21% lower than that before ECC; The concentration of T4 didn't decrease obviously after ECC and the first day post-operatively, but decreased from 7.65±1.73ug/dl to 5.81±1.30ug/dl on the second day after ECC, and recovered to the level before ECC on the fourth day. The concentration of TSH increased rather than decreased after ECC, but decreased obviously on the first and second day after operation, from 1.71±1.34uIU/L to 0.38±0.24uIU/L and 0.57±0.54uIU/L, which was 78% and 66% lower. Then it recovered to the level before ECC on the fourth day.
Conclusion: ECC surgery in infants is a definite risk factor related to Euthyroid Sick Syndrome, especially for low birth weight infants. Infants weighting less than 10kg undergoing ECC surgeories could develop type II Euthyroid Sick Syndrome perioperatively and the concentrations of T3, T4 and TSH decreases at different time points. ECC surgery has great effects on the level and function of thyroid hormone of infants, especially for low birth weight infants, so it makes great sense to monitor the thyroid hormone level of the infants perioperatively and supplement thyroid hormone early after surgery.
引文
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3 Awais D,Shao Y,Ismail-beigi F.Thyroid hormone regulation of myocardial Na~+-K~+-ATPase gene expression[J].Mol Cell Physiol,2004,286(3):580-585
4 张雅中,房辉,张丹等。甲状腺激素对大鼠心肌Na~+-K~+-ATP酶al亚基表达的影响[J].中国地方病学杂志,2007,26(3):263-265
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17 Peeters RP, Wouters PJ, van Toor H, et, al. Van den Berghe G: Serum 3,3',5'-triiodothyronine(rT3) and 3,5,3'-triiodothyronine/rT3 are prognostic markers in critically ill patients and are associated with postmortem tissue deiodi-nase activities [J]. Clin Endocrinol Metab 2005, 90:4559-4565
18 Ray DC, Macduff A, Drummond GB, et, al. Endocrine measurements in survivors and non-survivors from critical illness[J]. Intensive Care Med 2002, 28:1301-1308
19 Holland FW, Brown PS, Weitraub BD, et al. Cardiopulmonary bypass and thyroid function: a euthyroid sick syndrome[J].Ann thorac Surg, 1991,59: 46-50
20 Kobaschi G, Fesani F. Cardiopulmonary bypass a low T4 and T3 syndrome with Wanted thyrotropin(TSH) response to thyrotropin releasing hormone (TRH)[J]. Horm Res, 1986,23 (5): 516-523
21 Bremener WF, Taycor KM, Baird S, et al. Hyoehalamopitaitary thyroid axis function during cardiopulmonary bypass[J]. Thorac Cardiovasc Surg, 1991,7(4):S36
22 Torpy DJ, Tsigos C, Lotsikas AJ, et al. Acute and delayed effects of a single-dose injection of interleukin-6 on thyroid function in healthy humans[J]. Metabolism 1998,47:1289-1293
23 Saatvedt K, Lindberg H. Depressed thyroid function following paediatric cardiopulmonary bypass: association with inter-leukin-6 release [J]? Scand J Thorac Cardiovasc Surg 1996, 30:61-64
24 McMahon CK, Klein I, Ojamaa K. Interleukin-6 and thyroid hormone metabolism in pediatric cardiac surgery patients[J]. Thyroid. 2003 Mar; 13(3):301-4.
25 Holzer R, Bockenkamp B, Booker P, et al. The impact of cardiopulmonary bypass on selenium status, thyroid function, and oxidative defense in children[J]. Pediatr Cardiol 2004, 25:522-528
26 Saatvedt K, Lindberg H, Geiran OR, et al. Thyriod function during and after cardiopulmonary bypass in child[J]. Acta Anesthesiol Scand, 1998,42(9): 1100-1103
27 Thrush DN. Cardiopulmonary bypass temperature does not affect postoperative euthyroid sick syndrome[J]? Chest,1995,108(6): 1541-1545
28 Campagnolo M, Pesaresi A, Zelezetsky I, et al. Structural studies on Pax-8 Prd domain/DNA complex[J]. Biomol Struct Dyn, 2007,24:429-442
29 Zhang P, Zuo H, Nakamura Y, et al. Immunohistochemical analysis of thyroid-specific transcription factors in thyroid tumors[J]. Pathol,2006,56:240-245
30 Ratge D, Hansel-Bessey S, Wisser H. Altered plasma catecholamines and numbers of a-and 6-adrenergic receptors in platelets and leucocytes in hyperthyroid patients normalized under antithyroid treatment[J]. Acta Endocrinol (Copenh) 1985,110:75-82
31 Muntz KH. Autoradiographic characterization of 6-adrenergic receptor subtype in the canine conduction system[J]. Circ Res 1992,71:51-57
32 Linder N, Davidovitch N, Reichman B, et al. Topical iodine-containing antiseptics and subclinical hypothyroidism in preterm infants[J]. Pediatr 1997, 131:434-439
33 Harjai KJ, Licata AA. Effects of amiodarone on thyroid function[J]. Ann Intern Med ,1997,126:63-73
34 Kodama I, Kamiya K, Toyama J, et al. Cellular electropharmacology of amiodarone[J]. Cardiovasc Res 1997,35:13-29
35 Daniels GH. Clinical review: amiodarone-induced thyrotoxicosis[J]. Clin Endocrinol Metab,2001, 86:3-8
36 Hartong R, Wiersinga WM, Plomp TA. Amiodarone reduces the effects of T_3 on 6-adrenergic receptor density in rat heart[J]. Horm Metab Res 1990, 22:85-89
37 Novitzky D, Copper DK, Swanepoel A. Intropic effect of triiodothyronine(T3) in low cardiac output following cardioplegic arrest and cardiopulmonary bypass :an initial experience in patients undergoing open-heart surgery [J]. Eur J Cardiothorac Surg, 1989,3(2): 140-145
38 Helens ET. Acute L-triiodothyronine administration potentates intropic responses to β -adrenergic stimulation in the isolated perfused rat heart[J]. Cardionase Res, 1996,32(2):306-309
39 Klemperer JD. Triiodothyronine improves left ventricular function without oxygen wasting effects after global hypothemic ischmia[J]. Thorac Cardiovasc Surg, 1995,109(3): 457-465
40 Novitzky D, Fontanet H, Snyder M, et al. Impact of triiodothyronine on the survival of high-risk patients undergoing open heart surgery [J]. Cardiology, 1996, 87(6):509-515
41 Rosendale JD, Kauffman HM, Mcbride Ma, et al. Hormonal resuscitation yields more thansplanted hearts, with improves early function[J].Transplantation,2003, 75(8):1336-1341
42 Ellman PI, Ronson RS, Kron IL. Modern concepts in heart transplantation[J]. Long Term Eff Med Implants,2003,13(6):465-483
43 Jeevanandam V. Triiodothyronine: spectrum of use in hear transplantation[J]. Tryriod,1997,7(1):139-145
44 Mainwaring RD, Capparelli E, Schell K, et al. Pharmacokinetic evaluation of triiodothyronine supplementation in children after modified Fontan procedure[J]. Circulation 2000,101:1423-1429
45 Plumpton K, Haas NA. Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass[J]. Intensive Care Med 2005, 31:581-587
46 Carrel T, Eckstein F, Englberger L, Mury R, Mohacsi P: Thyronin treatment in adult and pediatric heart surgery: clinical experience and review of the literature[J]. Eur J Heart Fail 2002,4:577-582
47 Portman MA, Fearneyhough C, Ning XH, et al. Triiodothyronine repletion in infants during cardiopulmonary bypass for congenital heart disease[J]. Thorac Cardiovasc Surg 2000,120:604-608
48 Klemperer JD, Klein I, Gomez M, et al. Thyroid hormone treatment after coronary-artery bypass surgery[J]. N Engl J Med 1995, 333:1522-1527
49 Mullis-Jansson SL, Argenziano M, Corwin S, et al. A randomized double-blind study of the effect of triiodothyronine on cardiac function and morbidity after coronary bypass surgery[J]. Thorac Cardiovasc Surg 1999,117:1128-1134
50 Bettendorf M, Schmidt KG, Grulich-Henn J, et al. Tri-iodothyronine treatment in children after cardiac surgery: a double-blind, randomised, placebo-controlled study[J]. Lancet 2000,356:529-534
51 Sirlak M, Yazicioglu L, Inan MB, et al. Oral thyroid hormone pretreatment in left ventricular dysfunction[J]. Eur J Cardiothorac Surg 2004, 26:720-725
52 Valerio PG, van Wassenaer AG, de Vijlder JJ, et al. A randomized, masked study of triiodothyronine plus thyroxine administration in preterm infants less than 28 weeks of gestational age: hormonal and clinical effects[J]. Pediatr Res 2004, 55:248-253
53 Bartkowski R, Wojtalik M, Korman E, et al. Thyroid hormones levels in infants during and after cardiopulmonary bypass with ultrafiltration[J]. Eur J Cardiothorac Surg 2002,22:879-884
54 Magalhaes AP, Gus M, Silva LB. Oral triiodothyronine for the prevention of thyroid hormone reduction in adult valvular cardiac surgery [J]. Braz J Med Biol Res. 2006 Jul; 39(7):969-78
55 Mackie AS, Booth KL, Newburger JW, et al.A randomized, double-blind, placebo-controlled pilot trial of triiodothyronine in neonatal heart surgery [J]. Thorac Cardiovasc Surg 2005, 130:810-816
56 Bennett-Guerrero E. Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery. A randomised double-blind, placebo-controlled trial[J]. JAMA, 1996, 275(9):687-692
57 Guden M. Effects of intravenous triiodothyronine during coronary artery bypass surgery[J]. Asian Cardiovasc Thorac Ann,2002,10(3):219-222
58 Burmeister LA, Flores A. Subclinical thyrotoxicosis and the heart[J]. Thyroid 2002,12:495-499
59 Spratt DI, Frohnauer M, Cyr-Alves H. Physiological effects of nonthyroidal illness syndrome in patients after cardiac surgery [J]. Am J Physiol Endocrinol Metab. 2007 Jul, 293(1):E310-5
60 Portman MA, Fearneyhough C, Karl TR, et al. The Triiodothyronine for Infants and Children Undergoing Cardiopulmonary Bypass (TRICC) study: design and rationale[J]. Am Heart J 2004,148:393-398
61 Plumpton K, Haas NA: Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass[J]. Intensive Care Med 2005, 31:581-587
62 Carrel T, Eckstein F, Englber L, et al. Thyronin treatment in adult and pediatric heart surgery: clinical experience and review of the literature [J]. Eur J Heart Fail,2002,4(5):577-582
2 Balkman C,Ojamma K,Klein I.The course of in vivo effects of thyroid hormone on cardiac gene express[J].Endocrinology,1992,130:2001-2004
3 Ojamma K,Samarel AM,Kupfer JM,et al.Thyroid hormone effects on cardiac expression independent of cardiac growth and rotein synthesis[J].Am J Physiol,1992,263(3):534-540
4 Awais D,Shao Y,Ismail-beigi F.Thyroid hormone regulation of myocardial Na+-K+-ATPase gene expression[J].Mol Cell Physiol,2004,286(3):580-585
5 张雅中,房辉,张丹等.甲状腺激素对大鼠心肌Na~+-K~+-ATP酶al亚基表达的影响[J].中国地方病学杂志,2007,26(3):263-265
6 Burmeister LA,Flores A.Subclinical thyrotoxicosis and the heart[J].Thyroid 2002,12:495-499
7 Taddei S,Caraccio N,Virdis A,et al.Impaired endothelium-dependent vasodilatation in subclinical hypothyroidism:beneficial effect of levothyroxine therapy[J].Clin Endocrinol Metab,2003,88:3731-3737
8 Ojamma K,Balkman C,Klein I.Acute effects of triiodothyronine on arterial smooth muscle cells[J].Ann Thorac Surg 1993,56:S61
9 Danzi S,Klein I.Thyroid hormone-regulated cardiac gene expression and cardiovascular disease[J].Thyroid,2002,12:467-472
10 Goldman S,Olajos M,Morkin E.Control of cardiac output in thyrotoxic calves:evaluation of changes in the systemic circulation[J].Clin Invest,1984,73:358-365
11 Umpierrez GE.Euthyroid sick syndrome[J].South Med J 2002,95:506-513.
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14 Peeters RP, Wouters PJ, Kaptein E, et al. Reduced activation and increased inactivation of thyroid hormone in tissues of critically ill patients[J]. Clin Endocrinol Metab 2003, 8:3202-3211
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21 Peeters RP, Wouters PJ, van Toor H, et al. Serum 3,3',5'-triiodothyronine (rT3) and 3,5,3'-triiodothyronine/rT3 are prognostic markers in critically ill patients and are associated with postmortem tissue deiodi-nase activities[J]. Clin Endocrinol Metab 2005, 90:4559-4565
22 Zargar AH, Ganie MA, Masoodi SR, et al. Prevalence and pattern of sick euthyroid syndrome in acute and chronic non-thyroidal illness: its relationship with severity and outcome of the disorder[J]. Assoc Physicians India 2004, 52:27-31
23 Duntas LH, Nguyen TT, Keck FS, et al. Changes in metabolism of TRH in euthyroid sick syndrome[J]. Eur J Endocrinol 1999,141:337-341
24 Ray DC, Macduff A, Drummond GB, et al. Endocrine measurements in survivors and non-survivors from critical illness[J]. Intensive Care Med 2002, 28:1301-1308
25 Saatvedt K, Lindberg H, Geiran OR, et al. Thyroid function during and after cardiopulmonary bypass in children[J]. Acta Anaesthesiol Scand 1998, 42:1100-1103
26 Ross OC, Petros A. The sick euthyroid syndrome in paediatric cardiac surgery patients[J]. Intensive Care Med 2001,27:1124-1132
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30 Mainwaring RD,Lamberti JJ,Billman GF,et al.Suppression of the pituitary thyroid axis after cardiopulmonary bypass in the neonate[J].Ann Thorac Surg 1994,58:1078-1082
31 Mackie AS,Booth KL,Newburger JW,et al.A randomized,double-blind,placebo-controlled pilot trial of triiodothyronine in neonatal heart surgery[J].Thorac Cardiovasc Surg 2005,130:810-816
32 Bettendorf M,Schmidt KG,Grulich-Henn J,et al.Tri-iodothyronine treatment in children after cardiac surgery:a double-blind,randomised,placebo-controlled study[J].Lancet 2000,356:529-534
33 Chowdhury D,Ojamaa K,Parnell VA,et al.A prospective randomized clinical study of thyroid hormone treatment after operations for complex congenital heart disease[J].Thorac Cardiovasc Surg 2001,122:1023-1025
34 Holland FW,Brown PS,Weitraub BD,et al.Cardiopulmonary bypass and thyroid function:a euthyroid sick syndrome[J].Ann thorac Surg 1991,59:46-50V5 Kobaschi G,Fesani F.Cardiopulmonary bypass a low T4 and T3 syndrome with blanted thyrotropin(TSH)response to thyrotropin releasing hormone(TRH)[J].Horm Res,1986,23(5):516-523
36 Afandi B,Vera R,Schussler GC,et al.Concordant decreases of thyroxine and thyroxine binding protein concentrations during sepsis[J].Metabolism 2000,49:753-754
37 Lynch BA,Brown DM,Herrington C,et al.Thyroid dysfunction after pediatric cardiac surgery[J].Thorac Cardiovasc Surg 2004,27:1509-1511
38 Bremener WF,Taycor KM,Baird S,et al.Hyoehalamopitaitary thyroid axis function during cardiopulmonary bypass[J].Thorac Cardiovasc Surg,1991,7(4):S36
39 Holzer R,Bockenkamp B,Booker P,et al.The impact of cardiopulmonary bypass on selenium status,thyroid function,and oxidative defense in children[J]. Pediatr Cardiol 2004,25:522-528
40 Torpy DJ, Tsigos C, Lotsikas AJ,et al. Acute and delayed effects of a single-dose injection of interleukin-6 on thyroid function in healthy humans[J]. Metabolism 1998,47:1289-1293
41 Saatvedt K, Lindberg H. Depressed thyroid function following paediatric cardiopulmonary bypass: association with inter-leukin-6 release[J]? Scand J Thorac Cardiovasc Surg 1996,30:61-64
42 McMahon CK, Klein I, Ojamaa K. Interleukin-6 and thyroid hormone metabolism in pediatric cardiac surgery patients[J]. Thyroid 2003 Mar, 13 (3):301-4
43 Klemperer JD, Klein I, Gomez M, et al. Thyroid hormone treatment after coronary-artery bypass surgery[J]. N Engl J Med 1995, 333:1522-1527
44 Nagaya T,Fujioda M,Otsuka G, et al. A potential role of activates NF-KB in the pathogenesis of euthyriod sick syndrome[J]. Clin Invest 2000, 106(3): 393-402
45 Saatvedt K, Lindberg H, Geiran OR, et al. Thyriod function during and after cardiopulmonary bypass in child[J]. Acta Anesthesiol Scand , 1998, 42(9):1100-1103
46 Thrush DN. Cardiopulmonary bypass temperature does not affect postoperative euthyroid sick syndrome[J]? Chest, 1995,108(6): 1541-1545
47 Campagnolo M, Pesaresi A, Zelezetsky I, et al. Structural studies on Pax-8 Prd domain/DNA complex[J]. Biomol Struct Dyn, 2007,24:429-442
48 Zhang P, Zuo H, Nakamura Y, et al. Immunohistochemical analysis of thyroid-specific transcription factors in thyroid tumors[J]. Pathol,2006,56:240-245
49 Ratge D, Hansel-Bessey S, Wisser H. Altered plasma catecholamines and numbers of α- and β-adrenergic receptors in platelets and leucocytes in hyperthyroid patients normalized under antithyroid treatment[J]. Acta Endocrinol (Copenh)1985,110:75-82
50 Muntz KH. Autoradiographic characterization of 6-adrenergic receptor subtype in the canine conduction system[J]. Circ Res 1992,71:51-57
51 Linder N, Davidovitch N, Reichman B, et al. Topical iodine-containing antiseptics and subclinical hypothyroidism in preterm infants[J]. Pediatr 1997, 131:434-439
52 Harjai KJ, Licata AA. Effects of amiodarone on thyroid function[J]. Ann Intern Med 1997,126:63-73
53 Kodama I, Kamiya K, Toyama J. Cellular electropharmacology of amiodarone[J]. Cardiovasc Res 35:13-29
54 Daniels GH. Clinical review: amiodarone-induced thyrotoxicosis[J]. Clin Endocrinol Metab 2001,86:3-8
55 Hartong R, Wiersinga WM, Plomp TA. Amiodarone reduces the effects of T3 on 13-adrenergic receptor density in rat heart[J]. Horm Metab Res 1990,22:85-89
56 Allen DB, Dietrich KA, Zimmerman JJ. Thyroid hormone metabolism and level of illness severity in pediatric cardiac surgery patients[J]. Pediatr 1989, 114:59-62
57 Mainwaring RD, Nelson JC. Supplementation of thyroid hormone in children undergoing cardiac surgery [J]. Cardiol Young 2002,12:211-217
58 Novitzky D, Copper DK, Swanepoel A. Intropic effect of triiodothyronine(T3) in low cardiac output following cardioplegic arrest and cardiopulmonary bypass: an initial experience in patients undergoing open-heart surgery [J]. Eur J Cardiothorac Surg 1989, 3(2): 140-145
59 Tielens ET. Acute L-triiodothyronine administration potentates intropic responses to β -adrenergic stimulation in the isolated perfused rat heart [J]. Cardionase Res 1996, 32(2):306-309.
60 Klemperer JD. Triiodothyronine improves left ventricular function without oxygen wasting effects after global hypothemic ischmia[J]. Thorac Cardiovasc Surg, 1995,109(3): 457-465
61 Kokkonen L, Majahalme S, Koobi T, et al. Atrial fibrillation in elderly patients after cardiac surgery: postoperative hemodynamics and low postoperative serum triiodothyronine[J]. Cardiothorac Vasc Anesth 2005,19:182-187
62 Novitzky D, Fontanet H, Snyder M, et al. Impact of triiodothyronine on the survival of high-risk patients undergoing open heart surgery [J]. Cardiology, 1996,87(6):509-515
63 Rosendale JD, Kauffman HM, Mcbride Ma, et al. Hormonal resuscitation yields more thansplanted hearts with improves early function[J]. Transplantation 2003,75(8): 1336-1341
64 Ellman PI, Ronson RS, Kron IL. Modern concepts in heart transplantation[J]. Long Term Eff Med Implants,2003,13(6):465-483
65 Jeevanandam V. Triiodothyronine: spectrum of use in heart transplantation [J]. Tryriod 1997, 7(1): 139-145
66 Plumpton K, Haas NA. Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass[J], Intensive Care Med 2005,31:581-587
67 Carrel T, Eckstein F, Englberger L, Mury R, Mohacsi P: Thyronin treatment in adult and pediatric heart surgery: clinical experience and review of the literature[J]. Eur J Heart Fail 2002,4:577-582
68 Portman MA, Fearneyhough C, Karl TR, et al. The Triiodothyronine for Infants and Children Undergoing Cardiopulmonary Bypass (TRICC) study: design and rationale[J]. Am Heart J 2004,148:393-398
69 Burmeister LA, Flores A. Subclinical thyrotoxicosis and the heart[J]. Thyroid 2002,12:495-499
70 Fazio S, Biondi B, Carella C, et al. Diastolic dysfunction in patients on thyroid-stimulating hormone suppressive therapy with levothyroxine: beneficial effect of 6-blockade[J]. Clin Endocrinol Metab 1995,79: 2222-2226
71 Guden M. Effects of intravenous triiodothyronine during coronary artery bypass surgery[J]. Asian Cardiovasc Thorac Ann 2002, 10(3): 219-222
72 Bennett-Guerrero E. Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery [J]. A randomised double-blind, placebo-controlled trial[J]. JAMA, 1996, 275(9): 687-692
73 Spratt DI, Frohnauer M, Cyr-Alves H. Physiological effects of nonthyroidal illness syndrome in patients after cardiac surgery [J]. Am J Physiol Endocrinol Metab 2007 Jul, 293(1): E310-5
74 Mullis-Jansson SL, Argenziano M, Corwin S, et al. A randomized double-blind study of the effect of triiodothyronine on cardiac function and morbidity after coronary bypass surgery[J]. Thorac Cardiovasc Surg 1999,117:1128-1134
75 Sirlak M, Yazicioglu L, Inan MB, et al. Oral thyroid hormone pretreatment in left ventricular dysfunction[J]. Eur J Cardiothorac Surg 2004,26:720-725
76 Magalhaes AP, Gus M, Silva LB. Oral triiodothyronine for the prevention of thyroid hormone reduction in adult valvular cardiac surgery[J]. Braz J Med Biol Res 2006 Jul; 39(7): 969-78
77 Klemperer JD, Klein I, Gomez M, et al. Thyroid hormone treatment after coronary-artery bypass surgery[J]. N Engl J Med 1995, 333:1522-1527
78 Bettendorf M, Schmidt KG, Grulich-Henn J, et al. Tri-iodothyronine treatment in children after cardiac surgery: a double-blind, randomised, placebo-controlled study[J]. Lancet 2000, 356:529-534
79 Valerio PG, van Wassenaer AG, de Vijlder JJ, et al. A randomized, masked study of triiodothyronine plus thyroxine administration in preterm infants less than 28 weeks of gestational age: hormonal and clinical effects[J]. Pediatr Res 2004, 55:248-253
80 Carrel T, Eckstein F, Englberger L, et al. Thyronin treatment in adult and pediatric heart surgery: clinical experience and review of the literature[J]. Eur J Heart Fail 2002,4:577-582
81 Mackie AS, Booth KL, Newburger JW, et al. A randomized, double-blind, placebo-controlled pilot trial of triiodothyronine in neonatal heart surgery [J]. Thorac Cardiovasc Surg 2005,130:810-816
82 Bartkowski R, Wojtalik M, Korman E, et al. Thyroid hormones levels in infants during and after cardiopulmonary bypass with ultrafiltration[J]. Eur J Cardiothorac Surg 2002, 22: 879-884
83 Haas NA, Camphausen CK. Triiodothyronine in neonatal heart surgery: looking for an answer[J]. Thorac Cardiovasc Surg 2006 Feb, 131(2):505-506.
84 Portman MA, Fearneyhough C, Karl TR, Tet al. The Triiodothyronine for Infants and Children Undergoing Cardiopulmonary Bypass (TRICC) study: design and rationale[J]. Am Heart J 2004,148:393-398
85 Plumpton K, Haas NA. Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass[J]. Intensive Care Med 2005, 31:581-587.
1 Balkman C,Ojamma K,Klein I.The course of in vivo effects of thyroid hormone on cardiac gene express[J].Endocrinology,1992,130:2001-2004
2 0jamma K,Samarel AM,Kupfer JM,et al.Thyroid hormone effects on cardiac expression independent of cardiac growth and rotein synthesis[J].Am J Physio,1992,263(3):534-540
3 Awais D,Shao Y,Ismail-beigi F.Thyroid hormone regulation of myocardial Na~+-K~+-ATPase gene expression[J].Mol Cell Physiol,2004,286(3):580-585
4 张雅中,房辉,张丹等。甲状腺激素对大鼠心肌Na~+-K~+-ATP酶al亚基表达的影响[J].中国地方病学杂志,2007,26(3):263-265
5 Ojamma K,Balkman C,Klein I.Acute effects of triiodothyronine on arterial smooth muscle cells[J].Ann Thorac Surg 1993,56:S61
6 Danzi S,Klein I.Thyroid hormone-regulated cardiac gene expression and cardiovascular disease[J].Thyroid,2002,12:467-472
7 Goldman S,Olajos M,Morkin E.Control of cardiac output in thyrotoxic calves:evaluation of changes in the systemic circulation[J].Clin Invest,1984,73:358-365
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15 Siddiqi A, Parsons MP, lewis JL, et al. TR expression and function in human bone marrow stromal and osteoblast-like cells[J]. Clin Endocrinol Metab,2002, 87:906-914
16 Ovadia D, Bernardo V, Zeev J, et al. Relationship between changes in thyroid hormone level and severity of the postoperative course in neonates undergoing open-heart surgery[J]. Pediatric Anesthesia 2006,16: 538-542
17 Peeters RP, Wouters PJ, van Toor H, et, al. Van den Berghe G: Serum 3,3',5'-triiodothyronine(rT3) and 3,5,3'-triiodothyronine/rT3 are prognostic markers in critically ill patients and are associated with postmortem tissue deiodi-nase activities [J]. Clin Endocrinol Metab 2005, 90:4559-4565
18 Ray DC, Macduff A, Drummond GB, et, al. Endocrine measurements in survivors and non-survivors from critical illness[J]. Intensive Care Med 2002, 28:1301-1308
19 Holland FW, Brown PS, Weitraub BD, et al. Cardiopulmonary bypass and thyroid function: a euthyroid sick syndrome[J].Ann thorac Surg, 1991,59: 46-50
20 Kobaschi G, Fesani F. Cardiopulmonary bypass a low T4 and T3 syndrome with Wanted thyrotropin(TSH) response to thyrotropin releasing hormone (TRH)[J]. Horm Res, 1986,23 (5): 516-523
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