甲状腺激素治疗扩张型心肌病心力衰竭的初步研究

A preliminary study of thyroid hormone in the treatment of dilated cardiomyopathy with heart failure

目的 :观察扩张型心肌病 (DCM)心力衰竭患者甲状腺激素 (TH)的异常代谢 ,评估 TH治疗该病的疗效。方法 :19例 DCM心力衰竭患者随机分为观察组和对照组 ,观察组在对照组常规抗心力衰竭治疗基础上加服小剂量左旋甲状腺素 (L- T4) ,疗程 4周 ,治疗前后测血清 TH水平 ,以超声心动图、Holter及 X线胸片观察心脏各参数变化。结果 :患者血清 FT3、FT4明显降低 ,经 L- T4治疗后血清 FT3、FT4升高 ,左室内径缩小 ,室壁增厚 ,左室收缩、舒张功能显著提高。结论 :DCM心力衰竭患者存在低 TH状态 ,经 L- T4补充治疗后 ,心功能改善 ,临床好转。

Objective:To investigate the secondary abnormal thyroid hormone metabolism in the congestive heart failure (CHF) patients caused by dilated cardiomyopathy (DCM),and to evaluate the therapeutic effect of thyroid hormone in it.Method:①Measured the levels of serum free triiodothyronine (FT 3)、free thyroxin (FT 4)、thyroid stimulating hormone (TSH) on 19 CHF patients caused by DCM,then compared them with 10 healthy peoples;② All the patients were randomly divided into observation group and control group.Cases in control group were treated with conventional method,such as cardiotonic,diuretic and vessel dilator.Levothyroxine (L T 4) was added in the observation group.The cardiac morphologic and functional parameters in the two groups were examined with echocardiography;The heart thorax ratios were measured by chest X ray;The changes of heart rate and cardiac arrhythmias were monitored with holter.Result:The levels of serum FT 3、FT 4 on 19 DCM patients were lower than those of the healthy people,while the TSH was the same compared with the healthy ones.After the treatment,the internal diameter of left ventricular in observation group became shorter.The cardiac output was increased from ( 2.65 ± 0.66 )L/min to ( 3.31 ± 0.74 )L/min,P< 0.01 .The ejection fraction rose from ( 32.60 ± 7.06 )L/min to ( 40.10 ± 7.55 )L/min,P< 0.01 .The isovolumic relaxation time decreased from ( 0.13 ± 0.02 )s to ( 0.11 ± 0.02 )s,P< 0.05 .The total peripheral resistance was also reduced significantly,from ( 265.48 ± 54.52 ) kPa·s -1 ·L -1 to ( 202.19 ± 48.93 ) kPa·s -1 ·L -1 ,P< 0.01 .Conclusion:The levels of serum FT 3、FT 4 lowered in CHF patients from DCM,TSH didn′t change.After the supplemental treatment with L T 4,the levels of serum FT 3、FT 4 were raised,the patient′s cardiac function was improved;the clinical status became better.The results suggested that the thyroid hormone was safe and effective in treating dilated cardiomyopathy combined with heart failure.