甲亢性心脏病临床误诊分析

Analysis of clinical misdiagnosis for hyperthyroid heart disease

目的:探讨减少甲亢性心脏病误诊的对策。方法:回顾性分析广州市红十字会医院2003年1月至2010年6月收治的54例甲亢性心脏病患者的临床资料、实验室和辅助检查结果。结果:甲亢性心脏病患者的临床表现多不典型,常以心血管系统疾病的症状为就诊原因。心电图可表现为多种形式的心律失常,尤以房颤常见。心脏彩超可有不同程度房室增大的情况。多数患者血脂水平低于正常。结论:对于甲亢症状不明显、存在原因不明的心律失常、心衰或按常规心血管疾病方案治疗效果欠佳同时血脂又不高的患者,应警惕本病的可能。仔细询问病史、系统进行体格检查及甲状腺功能检测等可减少本病的误诊和漏诊。

Objective To explore the strategies to reduce chance in misdiagnosis of hyperthyroid heart disease.Methods Clinical data（including the results of laboratory examination and auxiliary examination） of 54 patients from January 2003 to June 2010 in Guangzhou Red-Cross Hospital were reviewed.Results The clinical manifestation of hyperthyroid heart disease was not typical.Symptom of cardiovascular system was the main reason for patients to see a doctor.These patients usually showed various kinds of arrhythmia,especially the atrial fibrilation.Different degree dilatation of cardiac atrium and/or cardiac ventricle could be found by echocardiography examination.Blood lipids in most patients were low.Conclusion For patients who have unknown causes for arrhythmia especially auricular fibrillation or congestive heart failure with low level of blood lipids,hyperthyroid heart disease could not be ruled out.Thorough history inquiry,systemic examination,and timely thyroid function test can reduce the chance of misdiagnosis effectively.