原发性甲状腺功能减退症致心肌酶增高46例临床分析

Clinical Analysis of Increased Myocardial Enzymes in Primary Hypothyroidism(Report of 46 cases)

目的:观察原发性甲状腺功能减退症患者心肌酶增高的临床相关因素。方法:原发性甲减伴心肌酶增高者46例,进一步分为A组(合并有心包积液组);B组(无心包积液组)。在初诊和经甲状腺片治疗2、4、8周时分别测定空腹血清FT3、FT4s、TSH,门冬氨酸氨基转移酶(AST)、肌酸激酶(CK)及其同工酶CK-MB、乳酸脱氢酶(LDH)及其同工酶HBDH、胆固醇(CHO)、甘油三酯(TG)。同时进行心脏超声、心电图检测。结果:治疗前FT3(游离T3)、FT4(游离T4)水平与所有心肌酶呈负相关,与sTSH呈正相关;CHO水平与FT3、FT4、sTSH水平显著相关,TG水平与FT3、FT4、sTSH无明显相关性;心包积液组与无心包积液组甲状腺功能、心肌酶增高例数无相关性,二组之间心肌酶增高程度有相关性,二组间心率对比有差异,统计学有意义;心电图变化与FT3、FT4、sTSH水平显著相关。结论:原发性甲减患者给甲状腺片治疗可显著降低心肌酶、胆固醇水平,可纠正心包积液及心电图异常。

Objective： To observe the related factors of increased myocardial enzymes in primary hypothyroidism. Methods： 46 cases of primary hypothy- roidism were divided in to two groups： group A with hydropericardium and group B without hydropericardium. Before and at 2 weeks, 4 and 8 weeks after treatment, the levels of serum FT3, FTo sTSH, AST, CK and CK - MB, LDH and HBDH, CHO and TG were measured. The cardiac ultrasound and ECG were detected. Results： Before treatment, FT3 and FT4 was negatively correlated with myocardial enzymes, but positively correlated with STSH. FT4, FT4 and STSH was marked correlated with CHO, but no correlated with TG. There was correlationship in the degree of increased myocardial enzymes, but no correlationship in the function thyroid gland and the nummer of increased myocardial enzymes between group A and group B The heart rate between two groups showed statistically difference. The changes in ECG was related to the levels of FT3, FT4 and sTSH. Conclusion： The thyroid tablet can markedly decrease the levels of myocardial enzymes and CHO, and improve the hydropericardium and abnormal ECG in Primary hypothyroidism.