充血性心力衰竭患者血清甲状腺激素和细胞因子的变化及临床意义

Clinical Significance of Changes of Serum Contents of Thyroid Hormones and Relevant Cytokine(TNF-α) in Patients with Congestive Heart Failure(CHF)

目的:通过对充血性心力衰竭(CHF)患者血清甲状腺激素及细胞因子的变化,来探讨其临床应用的价值。方法:采用放射免疫分析监测90例CHF患者及30例健康者血清游离三碘甲状腺原氨酸(FT3),游离甲状腺素(FT4),促甲状腺素(TSH),肿瘤坏死因子(TNF-α)的浓度变化,比较各组间的差异,并对FT3和TNF-α进行相关分析。结果:甲状腺激素的水平随心功能不同而变化,心功能Ⅳ级时FT3明显降低、TNF-α明显升高,与心功能Ⅱ级、Ⅲ级相比较有显著性差异(P<0.01或P<0.05);FT4略有下降,但与心功能Ⅱ级、Ⅲ级相比较无显著性差异(P>0.05)。相关性分析表明,FT3与TNF-α呈负相关(r=-0.577)。结论:CHF时甲状腺激素的代谢发生了明显的变化,而且心功能程度与甲状腺激素水平、细胞因子水平有明显的相关关系。

Objective To investigate the clinical significance of changes of serum levels of thyroid hormones and TNF -α in patients with CHF. Methods Serum FT3, FT4, TSH and TNF -α levels were measured with RIA in 90 patients with CHF and 30 controis. Results The serum levels of FT3 were significantly lower in the patients than those in controls （ P 〈 0. 01 ）, while the levels of TNF -α were significantly higher （P also 〈 0.01 ）. Among the CHF patients, the levels of FT3 were significantly lower and levels of TNF - ot were significantly higher in patients with grade Ⅳ （ n = 30） cardiac function than those in patients with grade Ⅱ （ n = 30） or grade Ⅲ （n = 30） cardiac function （P 〈 0.01 or P 〈 0.05）. Levels of FT4 in grade Ⅳ patients were lower than those in others, but not significantly. As a whole, levels of FT3 were negatively correlated with those of TNF -α. Conclusion Marked change of thyroid hormones metabolism was present in patients with CHF. Impairement of cardiac function was closely related to the changes of serum levels of FT3 and TNF - α.