冠状动脉粥样硬化性心脏病合并甲状腺功能异常的治疗

The treatment of coronary artery disease with thyroid dysfunction

目的 探讨冠状动脉粥样硬化性心脏病 (冠心病 )合并甲状腺功能异常的治疗策略。方法与结果 2 0 0 0年 5月到 2 0 0 3年 5月在我院心血管中心住院治疗的冠心病合并甲状腺功能异常 14例。其中ST段抬高的急性心肌梗死合并甲状腺功能减退 (甲减 ) 2例 ,1例直接经皮冠状动脉腔内成形术 (PTCA +支架 )治疗成功 ,1例广泛前壁心梗 ,尿激酶溶栓未通 ,未行介入治疗 ,死于左心衰。不稳定心绞痛 12例 ,其中合并甲状腺功能亢进 (甲亢 ) 5例 ,经药物治疗 ,4例心绞痛消失 ,1例心绞痛由Ⅳ级变为Ⅱ级 ,择期PTCA +支架置入治疗成功 ;合并甲减 7例 ,药物治疗 ,6例心绞痛消失 ,1例重症甲减心绞痛由Ⅱ级变为Ⅳ级 ,择期冠状动脉搭桥 (CABG)治疗成功。结论 ST段抬高的心肌梗死合并甲状腺功能异常应早期再灌注治疗 ;合并甲状腺功能异常的不稳定心绞痛 ,在药物稳定甲状腺功能基础上 ,行PTCA、CABG或药物治疗。

Objective To investigate the therapeutic principle of coronary artery disease(CAD) with thyroid dysfunction.Methods and Results 14 patients with CAD and thyroid dysfunction admitted to our Heart and Blood Vessel Center from May 2000 to May 2003 underwent different treatments.2 patients with ST segments elevation of acute myocardial infarction(AMI) and hypothyroidism, one of them got well after primary percutaneous transluminal coronary angioplasty (PTCA)+Stent, the other who was extensive anteroseptal infarction died of left heart failure without invasive treatment after ineffective urine kinase thrombolysis. In 12 patients with unstable angina (UA), five had hyperthyroidism. after drug therapy, UA of four patients disappeared after the improvement of thyroid function with medicine,PTCA+Stent succeeded in left patient. 7 patients had hypothyroidism, UA of six patients disappeared after the improvement of thyroid function with medicine, coronary artery bypass graft (CABG) succeeded in left patient. Conclusions Patients with ST segments elevation of AMI and thyroid dysfunction should undergo reperfusion at early phase; patients with UA and thyroid dysfunction should undergo PTCA、CABG or drug therepy.