小剂量左旋甲状腺素治疗尿毒症伴充血性心力衰竭的临床实验研究

Study on Effect of Small Dose Thyroid Hormone for Renal Failure Patients with Congestive Heart Failure

目的观察小剂量甲状腺素治疗伴有低三碘甲状腺素原氨酸（低T3）的尿毒症患者充血性心力衰竭的效果。方法选择进行血液透析的伴有充血性心力衰竭的尿毒症患者60例，随机分为治疗组和对照组，两组患者抗心衰基础治疗相同，治疗组加用左旋甲状腺素片12．5～25mg／d，对比治疗前后甲状腺素水平及心功能改善情况。观察时间6个月，每3个月复查相关指标。结果两组心功能均有改善，但治疗组心功能改善情况明显优于对比组，治疗组血清FT3（1．88±0．29pg／ml），FT4（1．51±0．79ng／dl）均恢复至正常水平，但治疗组升高更明显，两组治疗后心率和病死率无明显差异，再次住院人数治疗组明显减少46．7％（t=11．317，P〈0．05），同时治疗组治疗期间无甲亢表现。结论对于伴有心力衰竭的尿毒症患者在一定时期内补充小剂量甲状腺素能安全可靠的改善心功能，提高生活质量。

Objective To observe the effect of small dose thyroid hormone for renal failure patients with congestive heart failure and low triiodothyronine. Metheds 60 renal failure patients were randomly divided into tow groups. Treatment group （30） and control group （30）. Two groups were treated with base treatment for heart failure and hemodialysis. The treatment group were treated with thyroid hormone 12.5-25 mg/d. Then thyroid hormone level and heart function were observed before and after treatment. Results All patients heart function increased. Treatment group had higher improvement compared with control group. The serum FT3 and FT4 levels recovered to nonal （1.88-0. 29 pg/ml, 1.51±0. 79 ng/dl）. FT3 and FT4 level of treatment group was higher than those of control group. The heart rate and mortality were no statistical difference. Re-hospitalizing rate of treatment group was lower than that of control group （t = 11.31,P〈 0. 05）. Conclusion Small dose thyroid hormone for renal failure patients with congestive heart failure can obviously improve heart function and quality of life.