甲状腺功能亢进性心脏病左心结构与功能临床研究

STUDY ON THE STRUCTURE AND FUNCTION OF LEFT VENTRICLE IN PATIENTS WITH HYPERTHYRIOD HEART DISEASE

目的探讨甲状腺功能亢进(甲亢)性心脏病(HHD)病人左心功能与结构的改变和早期诊断。方法应用彩色多普勒超声显像仪检测31例单纯甲亢和65例HHD病人左、右心室舒张末期内径(LV、RV),舒张末期左心室后壁及室间隔的厚度(IVS、LVPW),收缩末期左、右心房横径(LA、RA);测量左心室舒张早期(E峰)及舒张晚期(A峰)二尖瓣最大血流速度,左心室射血分数(EF)。计算左心室质量(LVM)、左心室质量指数(LVMI)及舒张早晚期的最大血流速度比值(E/A),并与30例正常对照组比较。结果HHD病人早期LVMI明显高于对照组和单纯甲亢组,二尖瓣血流频谱E/A比值明显低于对照组和单纯甲亢组(F=5.47、20.32,q=4.93～5.10,P<0.01),而早期EF与对照组比较差异无显著性(P>0.05)。HHD病人早期左心房、左心室大于单纯甲亢组和对照组,右心房、右心室无明显的变化,晚期右心房、右心室大于HHD早期和单纯甲亢病人。HHD晚期EF低于对照组,差异有显著性(F=5.03,q=4.87,P<0.01),单纯甲亢病人EF高于对照组,差异有显著性(q=5.02,P<0.01)。结论甲亢病人左心室收缩功能增强。HHD病人早期出现左心舒张功能不全,收缩功能正常,晚期出现收缩功能不全。HHD病人先左心扩大,晚期全心扩大。LVMI结合E/A可早期诊断HHD。

Objective To study the changes and early diagnosis of structure and function of left ventricle in patients with hyperthyroid heart disease （HHD）. Methods Diameters of the left and right ventrcles （LV,RV）, thickness of the posterior wall of left ventricle （LVPW） and interventricular septum （IVS） at end-diastole, diameters of left and right atria （LA,RA） at end-systole, left ventricular ejection fraction （EF）, the peak value of mitral annular early diastolic velocity （E） and late diastolic velocity （A）, left ventricular mass and mass index （LVMI） were respectively measured by using color Doppler ultrasonography in 65 patients with HHD and 31 simple hyperthyroidism. Results A comparison between patients with early HHD and those with simple hyperthyroidism and controls showed LVMI was high in HHD, but E/A was lower （F= 5.47,20.32 ; q= 4.93- 5.10 ; P〈0.01）. The difference of EF was not significant between patients with early HHD and the normal controls （P〉0.05）. EF in patients with HHD in late stage was lower than the normal ones （F= 5.03,q= 4.87;P〈0.01）, and EF in those with simple hyperthyroidism was higher （q=5.02,P〈0.01）. Conclusion The systolic function of left ventricle in patients with hyperthyroidism enhances. In HHD, diastolic insufficiency appears in early stage, and systolic dysfunction in late stage, the dilatation of left atrium and ventricle goes first followed by total cardiac enlargement in advanced stage. An early diagnosis of HHD can be made by combination of LVMI and E/A.