心脏疾患心力衰竭患儿血清甲状腺激素的测定及意义

Determination and significance of serum thyroid hormones in pediatric patients with congestive heart failure

目的探讨心脏疾患及合并充血性心力衰竭(CHF)患儿心衰时,血清甲状腺激素(TH)水平的变化规律及临床意义。方法对2003-09—2006-09山西省阳泉市第一人民医院收治的116例心脏疾病患儿分为2组,心脏病合并CHF组82例,心脏病未合并CHF组34例,以28例健康体检儿童为对照组,均做如下检测及分析:(1)检测CHF患儿血清TH水平,包括三碘甲状腺原氨酸(T3)、游离T3(FT3)、甲状腺素(T4)、游离T4(FT4)、反T3(rT3)及促甲状腺激素(TSH),三组间进行比较。(2)以血清TH水平与心功能进行相关分析。(3)动态观察CHF患儿的血清TH水平,探索其变化规律。结果(1)CHF组与N-CHF组及正常对照组比,血清T3、FT3及FT4均显著降低(P<0.01),rT3显著升高(P<0.01)。(2)随心功能的下降,T3、FT3、T4、FT4渐降低,rT3渐升高。TSH与心功能变化无相关性。(3)CHF组经治疗后血清TH多恢复(P<0.01),顽固性心衰组则无恢复(P>0.05)。结论(1)小儿CHF伴有血清TH的改变,以T3、FT3及FT4的降低,rT3的升高为主,其改变程度与心功能状态具有相关性。(2)随着心功能的改善,TH的改变多渐恢复,顽固性心衰患儿则无恢复,提示TH水平持续不恢复者预后较差。

Objective To explore the changing rule of serum thyroid hormones （TH ） in pediatric patients with congestive heart failure （ CHF） through measuring the serum TH level in patients with CHF. Methods （ 1 ） Serum TH of patients with CHF were measured with radioimmunoassy and were compared with that of none CHF （ N-CHF ） group as well as normal control group. （2） The correlation between serum HT level and cardiac function was analysed. （3） Serum TH in patients with CHF was dynamically observed. Results （ 1 ） Triiodothyronine （ T3 ） , free triiodothyronine （ FT3 ） and free tetraiodothyronine （ F-T4 ） were significantly lower in patients with CHF in comparison with N-CHF group and normal control group （ P 〈 0. 01 ）, while reversed triiodothyronine （ rT3 ） was significantly higher （ P 〈 0. 01 ）. （ 2 ） Along with the aggrevation of heart failure, serum level of T3 , FT3 , tetraiodothyronine （ T4 ） and FT4 progressively decreased, while rT3 progressivly increased. （3） After 3 weeks treatment, serum TH level recovered in patients with remission of heart failure （ P 〈0. 01 ） ,while that in patients with stubborn heart failure did not recover. Conclusion （ 1 ） Serum thyroid hormones changes exist in pediatric patients with CHF and the extent of its change is correlated with cardiac function. （2） As the heart failure is corrected the abnormal serum TH level restores. A persistent abnormal serum TH is often found in patients with stubborn heart failure and implicates an unfavorable therapeutic effect.