美托洛尔辅小剂量甲状腺激素治疗充血性心力衰竭临床观察

Clinical observation of congestive heart failure treated by metoprolol assisted with low-dose thyroid hormone

目的观察β受体阻滞剂辅用小剂量甲状腺激素治疗充血性心力衰竭(CHF)的疗效,以探讨CHF患者对β受体阻滞剂治疗的耐受性及二药合用的可行性。方法将36例CHF患者随机分为:美托洛尔组(M组)和美托洛尔辅小剂量甲状腺激素组(MT组),M组口服美托洛尔起始量6.25～12.5mg,直至耐受量,MT组在M组的基础上加服甲状腺片10 mg,每日1次,共服3周。心排血量(CO)、左心室射血分数(LVEF)、左心室舒张末容积(LVEDV)、左心室收缩末容积(LVESV)和血浆三碘甲状腺原氨酸(T3)、甲状腺素(T4)、反三碘甲状腺原氨酸(rT3)及促甲状腺激素(TSH),于用药前和用药后3周各检查1次。结果 M组有3例出现低血压反应,其中1例有心力衰竭加重表现;MT组心功能改善和甲状腺激素水平恢复均优于M组,仅1例发生一过性低血压,心功能治疗后MT组与M组比:LVEF(46.23±7.65)%vs(38.72±7.02)%、LVEDV(169.32±45.56)ml vs(199.81±43.13)ml、LVESV(120.56±48.32)ml vs(153.36±47.26)ml、CO(3.86±0.73)L/min vs(3.37±0.63)L/min;甲状腺激素水平治疗后MT组与M组比较:T3(2.32±0.82)nmol/L vs(1.05±0.65)nmol/L、T4(105.32±60.31)nmol/L vs(103.62±52.11)nmol/L、rT3(0.49±0.26)nmol/L vs(0.69±0.31)nmol/L、TSH(5.12±2.43)mU/L vs(5.23±2.65)mU/L。结论美托洛尔辅以小剂量甲状腺素治疗CHF,可取长补短,有利于提高CHF患者对β受体阻滞剂的耐受性。

Objective To observe a -receptor blocker assisted with a small dose of thyroid hormone in treatment of congestive heart failure（CHF）,in order to investigate the tolerance of CHF on the β-recepor blocker treatment and the feasibility of two-drug combination. Methods Thirty-six cases of CHF patients were randomly divided into metoprolol group（M group） and metoprolol group secondary small dose of thyroid hormone group（MT group）, In M group,the initial dose of oral metoprolol was 6.25-12.5 mg, until the tolerance dose, in MT group, on the basis of conventional therapy,thyroid tablets 10mg, once a day, serving a total of three weeks. Cardiac output （CO）, left ventricular ejection fraetion（LVEF） ,left ventrieular end diastolic volume（LVEDV） ,left ventricular end systolic volume （LVESV） and plasma T3 ,T4, rT3 and TSH were inspected before treatment and after treatment three weeks. Results In M group,three cases had hypotension,one of them had clinical symptoms of worsening heart failure In MT group, the improvement of cardiac function and the recovery of thyroid hormone levels were better than those in M group,only 1 case had transient hypotension. In MT group and M group, comparison of cardiac function： LVEF （46.23 ± 7.65）% vs （38. 72±7.02）; ,LVEDV （169. 32±45.56） ml vs （199.81±43.13） mh LVESV（120. 56±48. 32） ml vs （153.36±47.26） ml,CO （3.86 ± 0.73） L/min vs （3.37 ± 0.63） L/min; compared thyroid hormone levels.. T3 （ 2.32 ± 0.82 ） nmol/L vs （1. 05±0.65） nmol/L,T4 （105. 32±60.31） nmol/L vs （103.62±52.11） nmol/L,rT3 （0. 49±0; 26） nmol/L vs （0. 695=0.31） nmol/L,TSH（5.12±2. 43） mU/L vs （5. 23±2.65） mU/L. Conclusion Metoprolol combined with low-dose thyroid hormone for CHF, can benefit each other,helping improve the tolerance of CHF patients on β-receptor blockers.