CHF患者对TH含量的影响及其临床意义

Clinical Significance of Changes of Serum Thyroid Hormones (TT_3, TT_4, rT_3,TSH) Levels in Patients with Congestive Heart Failure (CHF)

目的 :探讨充血性心力衰竭患者甲状腺激素含量的变化及其临床意义。方法 :采用放射免疫分析法和微粒子化学发光免疫分析法检测了 98例充血性心力衰竭患者、30例健康对照者和 6 4例患者治疗前后血清中的TT3 、TT4、TSH及rT3 含量。结果 :充血性心力衰竭患者血清TT3 水平明显降低 ,而血清rT3 、rT3 /TT3 、TSH水平均明显升高 ,与对照组比较有显著性差异 (P <0 .0 0 1 ) ,且与病情严重程度、年龄不同及病情长短有关。在治疗上 ,抗心衰药物有效率为 71 88% ,抗心衰药物加甲状腺激素的有效率为 93 75 % ,两组比较有显著性差异 (P <0 .0 2 5 )。结论 :充血性心力衰竭患者检测血清TT3 、rT3 、TT4、rT3 /TT3 、TSH含量 ,根据其浓度可作为诊断和判断病情严重程度指标之一 ,对于应用甲状腺激素治疗 。

Objective To explore the clinical significance of changes of serum thyroid hormones levels in patients with CHF. Methods Serum TT 3, TT 4, TSH (with microparticle chemiluminescence immunoassay) and rT 3 (with RIA) levels were determined in: ① 30 controls ② 98 patients with CHF at admision ③ 32 randomly selected patients treated with conventional measures ④ 32 randomly selected patients treated with additional thyroid hormone. Results In the CHF patients, serum TT 3 levels were significantly lower and serum rT 3, rT 3/TT 3, TSH levels significantly higher than those in the controls ( P <0.001). These changes became progressively more prominent with the advancement of the disease process. Treatment was effective (cardiac function promoted one or more grade) in only 71.88% of the patients treated conventrionally. With additional thyroid hormone, the effective rate was 93.75% (vs conventional, P <0.025). Conclusion Lowering of serum TT 3 and increasing of rT 3 levels are the main features of changes of thyroid homrones levels in patients with CHF; the degree of which being related to the severity of the heart failure. Treatment with additional thyroid hormone, though helpful, should be carefully monitored for the TT 3 levels to be kept within physiologic range.