左旋甲状腺素对充血性心力衰竭的心功能及β受体反应性的影响

Effects of L-thyroxine on cardiac function and β receptor responsibility in congestive heart failure

目的 探讨左旋甲状腺素对充血性心力衰竭 (CHF)的心功能及 β受体反应性的影响。 方法 2 3例CHF患者 ,男 13例 ,女 10例 ,平均年龄 6 3岁 ,随机分为对照组 :进行心力衰竭的一般治疗 ;治疗组 :另外加用左旋甲状腺素 (L -T4 ) 10 0μg ,Qd ,疗程 2周。治疗期间记录体温、食欲、出汗等甲亢症状 ,治疗前后进行ECG检查、血甲状腺激素水平的测定、超声心动图检查及进行多巴酚丁胺实验。结果 所有病例治疗期间无甲亢的症状 ,心功能明显好转 ;L -T4 治疗组心功能改善程度优于对照组 ,血清T4 比对照组明显升高 (P <0 0 0 1) ,TSH略有下降 (P <0 0 5 )。超声心动图显示两组心功能均好转 ,治疗组左心室舒张末期内径缩短更为明显。多巴酚丁胺实验显示治疗后两组平均动脉压及心率与治疗前相比均有显著性差异。结论 L -T4 短期应用无明显副作用 。

Objective To observe the effects of L-thyroxine on cardiac function and β response to dobutamine of congestive heart failure(CHF).Methods A total of 23 patients with CHF were enrolled in the study.10 patients were randomizely assigned to control group with general treatment,13 patients assigned as treatment group were administered L-thyroxine (100 μg/day,orally)for two weeks.Clinical signs and symptoms of hyperthyroidism were recorded at all study period,before and at the end of study period of treatment,every patient was measured plasma levels of T 3、T 4、TSH and free T 3、free T 4、rT 3.A 12-lead electrocardiogram were recorded,echocardiogram was examined to evaluate index of cardiac function,dobutamine was infused intraveneously to evaluate cardiac response to the adrenergic stimulation.Results All patients had no clinical signs and symptoms of hyperthyroidism,cardiac function class were improved in two groups,but treatment group had better improved than control group.Plasma T 4 level was obviously increased but TSH level has reduced after L-thyroxine treatment ( P <0 01 and P <0.05).Echocardiogram was found cardiac function of two groups had improved,but left ventricular end-diastolic diameter of treatment group had markedly changed compared with control group.Dobutamine infusion was showed heart rate after treatment had significant differences in two groups compared with before treatment( P <0 05) Conclusions L-thyroxine was well tolerated,and no adverse effects.Cardiac function and left ventricular end-diastolic diameter had improved in CHF patients. Therefore, administration of L-thyroxine might be helped in a short term. [