老年甲状腺功能亢进性心脏病的临床分析

Clinical Analysis of the Elderly Patients with Hyperthyroidism Heart Disease

目的分析老年甲状腺功能亢进性心脏病(HHD)的临床特点及不同心功能级别临床特点的差异。方法收集2000年4月-2009年4月住院老年HHD(80例)与无HHD的老年甲亢患者(180例)临床资料,分析HHD不同心功能级别的临床情况差异。结果 HHD老年组病程(70.52±10.04)个月,合并骨质疏松13例,肝功能损伤11例;无HHD老年甲亢组病程(32.59±7.83)个月,合并骨质疏松7例,肝功能损伤8例,两组比较有统计学意义(P<0.05)。老年HHD组伴发心房颤动51例。心功能Ⅳ级甲状腺不大者6例,心功能Ⅰ级甲状腺不大者1例;心功能Ⅲ级甲状腺Ⅲ度肿大者3例,心功能Ⅰ级甲状腺Ⅲ度肿大者0例;心功能Ⅱ级平均住院时间(14.43±6.99)天,心功能Ⅰ级平均住院时间(9.56±3.00)天,比较有统计学意义(P<0.05)。结论毒性弥漫性甲状腺肿是住院老年HHD最常见病因。老年HHD好发于病程长的患者,心律失常主要表现为心房颤动,病程越长心功能越差,心力衰竭程度与甲功及甲状腺肿大的程度不成比例。

Objective To analyze the clinical features of the elderly patients with hyperthyroidism heart disease （HHD） and the clinical differences in various stages of heart funtions. Methods Clinical data of elderly hyperthyroidism patients complicated with heart disease and without heart disease were collected from April 2000 to April 2009. The clinical features and the differences in various stages of heart function were summarized and analyzed. Results The hyperthyroidism course of the elderly with HHD was （70. 52 ± 10. 04） months. The number of cases of HHD complicated with osteoporosis was 13, and hepatic lesion was 11. The course of the elderly without HHD was （32. 59 ±7.83） months. The number of cases of HHD complicated with osteoporosis was 7, and hepatic lesion was 8. There were significant differences between two groups （P〈0. 05）. The number of HHD patients with atrial fibrillation was 51. The number of patients with normal thyroid gland in the elderly patients with HHD function IV was 6, and in the HHD function I was 1. The number of patients with in stage III enlarged thyroid gland in the elderly HHD function III was 3, and in the HHD function I was 0. The inhospital period of patients with class II was （14. 43±6.99） days and in the HHD function I was （9. 56±3. 00） days. There were significant differences （P〈0. 05）. Conclusion Graves disease is the most common cause in the HHD elderly hospitalized. HHD in the elderly hospitalized occurs fre quently in the patients with long course of disease. Atrial fibrillation is the most common feature of arrhythmia, and the heart function would be worse if the course gets longer. The stages of heart failure are not parallel with the degree of enlargement of thyroid gland.