小剂量甲状腺素对充血性心力衰竭患者心功能及预后的影响

Effects of Small Doses of Thyroxine on Cardiac Function and Prognosis in the Patients with Congestive Heart Failure

目的:观察小剂量左旋甲状腺素对充血性心力衰竭(CHF)患者心功能及预后的影响。方法:78例CHF患者随机分为对照组38例和治疗组40例。对照组给予心力衰竭常规治疗;治疗组在心力衰竭常规治疗基础上加用左旋甲状腺素(L-T4)50μg,1天1次,口服,疗程4周。两组治疗前后进行EKG检查、血清甲状腺素测定、超声心动图检查和6min步行距离测定,治疗期间观察体温、食欲、出汗等甲亢症状。结果:两组治疗期间均未出现甲亢症状,治疗组心功能、心超(LVEF、LVDd、E/A)、6min步行距离改善明显优于对照组(P<0.01),血清T3、FT3较对照组明显升高(P<0.01),TSH无明显变化;6个月后随访显示,治疗组因心力衰竭再次住院率较对照组显著降低(P<0.01)。结论:在常规抗心力衰竭治疗上加用短疗程小剂量甲状腺素,安全有效,可改善CHF患者心功能及预后。

Objective：to investigate the effects of small doses of thyroxine on cardiac function and prognosis in patients with congestive heart failure（CHF）. Methods：A total of 78 patients with CHF were randomly assigned to control group（38 patients） with general treatment and treatment group with L-thyroxine （50 μg per day, orally） in addition to general treatment for 4 weeks. Before and at the end of treatment,serum level of thyroxine was determined,a 12-lead electrocardiogram,echocardiogram,and 6-minute walk test were examined in each patient, arid temperature,apetite,and perspiration were observed in each patient. Results： All patients had no clinical signs and symptoms of hyperthyroidism and cardiac function was improved in both groups;LVEF, LVDd,and E/A were better and serum T3 and FT3 were higher in the treatment group as compared with those in the control group（ P 〈 0.01 ） ;the level of TSH did not change obviously in both groups. The rate of hospitalization in the treatment group in 6 months after treatment was lower than the control group（ P 〈 0. 01 ）. Conclusion： Small doses of thyroxine can effectively improve cardiac function and prognosis of CHF patients.