硒联合比索洛尔治疗自身免疫性甲状腺疾病合并阵发性房颤的临床观察

Clinical Observation of Selenium Combined with Bisoprol in the Treatment of Autoimmune Thyroid Disease(AITD) Complicating with Paroxysmal Atrial Fibrillation

目的:观察硒联合比索洛尔治疗自身免疫性甲状腺疾病(AITD)合并阵发性房颤的疗效。方法:将42例AITD合并阵发性房颤患者随机分为试验组(24例)与对照组(18例)。在服用华法林的基础上,试验组患者应用硒+比索洛尔治疗;对照组患者应用同等剂量安慰剂。经6个月治疗后,采用电化学发光免疫法对所有患者进行游离三碘甲状腺氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)含量检测以及甲状腺球蛋白抗体(TGAb)和甲状腺过氧化物酶抗体(TPOAb)测定。应用24h动态心电图检测进行心功能评价,并观察记录患者的不良反应情况。结果:与治疗前比较,对照组治疗后各指标均未见显著变化(P>0.05);与对照组及同组治疗前比较,试验组FT3、FT4未见显著变化(P>0.05),TSH则显著上升(P<0.05),TGAb、TPOAb则较治疗前显著下降(P<0.05),患者心率较治疗前显著下降,75%的患者房颤纠正、心脏左心室舒张功能明显改善。两组均未见明显不良反应发生。结论:硒联合比索洛尔治疗AITD合并阵发性房颤,可显著改善患者TSH、TGAb、TPOAb水平和左心室功能,且安全性较好。

OBJECTIVE： To observe clinical efficacy of selenium combined with bisoprol in the treatment of autoimmune thy- roid disease （AITD） complicating with paroxysmal atrial fibrillation. METHODS： 42 patients with AITD complicating with parox- ysmal atrial fibriUation were randomized into trial group （24 cases） and control group （18 cases）. On the basis of warfarin treat- ment, trial group received selenium combined with bisoprol, and control group was given counterpart dose of placebo. The levels of FT3, FT4, TSH, TGAb and TPOAb were determined by electrochemiluminescence immunoassay after 6 months of treatment. 24 h dynamic electrocardiograms were applied to measure the function of heart, and ADR of patients were recorded. RESULTS： Af- te＇r 6 months of combination treatment, the index of control group had no significant change in control group compared to before treatment （P〉0.05） ; compared with control group and before treatment, the levels of FT3 and FT4 in experiment group had no significant change （P〉0.05） ; TSH level increased significantly （P〈0.05）, while TGAb and TPOAb decreased significantly （P〈 0.05）; heart rate of patients decreased significantly compared to before treatment, and 75% patients with atrial fibrillation were cor- rected. Left ventricular diastolic function of heart improved obviously. No significant ADR was found in 2 groups. CONCLU- SIONS： Selenium combined with bisoprol in the treatment of AITD complicating with paroxysmal atrial fibrillation can improve TSH, TGAb and TPOAb levels and left ventricular function with sound safety.