放射性核素碘治疗甲状腺功能亢进性心脏病重要血浆因子水平的变化

The Change in Crucial Plasma Factor Levels of Patients with Hyperthyroid Cardiopathy under the Treatment of Radionuclides Iodine

目的观察甲状腺功能亢进性心脏病(甲亢性心脏病)患者接受放射性核素碘(131I)治疗前后血白细胞介素1(IL-1)、肿瘤坏死因子α(TNF-α)、内皮素水平的变化,探讨甲亢性心脏病与IL-1、TNF-α、内皮素的关系。方法选取2008年9月至2011年12月经新乡医学院第一附属医院收治126例甲状腺功能亢进患者为单纯甲亢组,另选取同期的甲亢性心脏病患者172例为甲亢性心脏病组。应用酶联免疫吸附法测定131I治疗甲亢性心脏病前后血IL-1、TNF-α、内皮素的水平,并观察甲状腺激素水平及超声心动参数左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)及左心室射血分数(LVEF)的变化。结果甲亢性心脏病脏病组患者治疗131I治疗前后血内皮素、TNF-α及IL-1均显著高于单纯甲亢组;甲亢性心脏病组患者131I治疗后血内皮素、TNF-α、IL-1、血清游离三碘甲腺原氨酸及血清游离甲状腺素显著下降,而TSH水平增高(P<0.05)。治疗后与治疗前比较,患者LVESD、LVEDD及LVEF的差异均有统计学意义(P<0.05)。结论 131I可能参与了IL-1、TNF-α、内皮素的生成调节,甲亢性心脏病患者的心功能和甲状腺功能的改善与上述因子水平变化有密切联系。

Objective To observe the changes in serum interleukin-1（IL-1）,tumor necrosis factor-α（TNF-α）,endothelin level of patients with hyperthyroid cardiopathy before and after the treatment of radionuclide iodine（131I） and explore the connection between hyperthyroid cardiopathy and IL-1,TNF-α,endothelin.Methods The records of 172 patients with hyperthyroid cardiopathy and 126 patients with only hyperthyroidism from the First Affiliated Hospital of Xinxiang Medical College treated during September 2008 to December 2011,were selected and divided into two groups-the hyperthyroid cardiopathy group and the hyperthyroidism group.The IL-1,TNF-α,endothelin levels of patients with hyperthyroid cardiopathy before and after the 131I treatment were measured by ELISA;thyroid hormone level,echocardiographic parameters of left ventricular internal systolic diameter and left ventricular diameter,and the change in left ventricular ejection fraction were observed.Results ET,TNF-α and IL-1 levels of patients with hyperthyroid cardiopathy were significantly higher than patients with only hyperthyroidism both before and after the 131I treatment;ET,TNF-α,IL-1,FT3 and FT4 levels of patients with hyperthyroid cardiopathy were significantly lower after the 131I treatment and the TSH level rose（P〈0.05）.Conclusion 131I can be used to control the secretion of Serum IL-1,TNF-α and endothelin of patients with hyperthyroid cardiopathy;cardiac function and thyroid function improvement are closely connected with the levels of aforementioned factors.