吡格列酮导致甲状腺功能变异及心肌酶学变化五例临床分析

Clinical analysis of pioglitazone induced low free triiodothyronine and cardiace enzyme in 5 cases

目的分析高血压病患者口服吡格列酮导致甲状腺功能变异以及心肌酶谱的变化。方法将我院2002年3月至2006年5月5例口服吡格列酮后导致低三碘甲状腺原氨酸（T3）及心肌酶变化患者的剂量、出现的时间及转归进行分析。观察患者的甲状腺功能、心肌酶谱及心脏超声变化。结果①5例患者出现心肌酶变化均为用药90—120d后，天冬氨酸氨基转移酶峰值为（180±45）U／L．肌酸磷酸激酶峰值为（600±60）U／L，停药后改善心肌代谢治疗后（24±7）d心肌酶恢复正常。②药物性心肌酶学变化患者出现T3、游离甲状腺素减低。结论长期口服吡格列酮可能会导致甲状腺功能变异和心肌酶谱的变化，应注意监测甲状腺功能。

Objective To analyze changes of cardiac enzyme and euthyoid function variation in hypertension patients treated with oral pioglitazone. Methods Indications of pioglitazone, characteristics of cardiac injury and prognosis of patients were reviewed in 5 cases between 2002 March and 2006 May. Free triiodothyronine （ FT3 ）, Free thyroxine （ FT4 ）, cardiac enzyme and were determined in patients. Results Five patients had an chronic increase in cardiac enzyme within （90 - 120）days of starting oral pioglitazone. The peak of GOT was （180 ±45）U/L and CPK was （540 ± 60）U/L. Discontinuation of pioglitazone resulted in decrease in cardiac enzyme levels to baseline values within （24 ± 7 ） days. Drugs cardiotoxicity showed decrease of Free triiodothyronine and Free thyroxine. Conclusion It is important to identify pioglitazone as a potential cause of euthyoid function variation and eardiaee enzyme. According/y, it is necessary to monitor cardiac function and the change of myocardium enzyme after longterm oral pioglitazone.