充血性心力衰竭患儿血清甲状腺激素水平的变化及意义

Change and significance of serum thyroid hormone in children with congestive heart failure

目的 探讨小儿充血性心力衰竭 (CHF ,简称心衰 )时血清甲状腺激素水平的变化及意义。方法 用放射免疫法分别测定 62例CHF患儿心衰急性期、恢复期及 3 6例正常对照组血清三碘甲状腺原氨酸 (T3)、四碘甲状腺原氨酸(T4)、促甲状腺激素 (TSH)、反三碘甲状腺原氨酸 (rT3)及T3与rT3的比值 (T3/rT3)。结果 CHF组急性期与对照组比较 :T3明显下降 ,P <0 0 5 ;rT3显著升高、T3/rT3显著下降 ,P均 <0 0 1;T4,TSH无明显改变。对照组与CHF组不同程度心衰患儿比较 :心衰越重 ,T3及T3 rT3下降越显著 ,rT3升高越显著 ,P均 <0 0 1。重度心衰患儿可出现T4显著下降 ,P <0 0 1,轻、中度心衰患儿T4无明显改变。心衰恢复期T3明显上升 ,P <0 0 5 ;rT3显著下降、T3 rT3显著上升 ,P均 <0 0 1。结论 心衰时可出现T3及T3 rT3下降 ,rT3上升 ,T4正常或下降 (重度心衰时 ,T4下降 )。甲状腺激素水平对CHF患儿心衰程度、病情、治疗及预后具有指导意义。

Objective To study the change and significance of serum thyroid hormone in children with congestive heart failure(CHF).Methods Serum triiodothyronine(T 3), tetraiodothyronine(T 4), thyroid stimulating hormone(TSH), reverse T 3(rT 3) levels, and the ratio of T 3/rT 3 were detected with immunoradiometric assay in 62 CHF patients at the acute stage and recovery stage, and in 36 normal children, respectively.Results In the acute stage of CHF, the serum T 3,T 3/rT 3 decreased and rT 3 increased significantly( P <0 01) than in control group, but T 4 and TSH were not significantly different from controls. The more serious the CHF, The lower T 3, T 3/rT 3 levels, and the higher rT 3 levels ( P <0 01).In addition, T 4 decreased significantly in the serious CHF patients ( P <0 01) and did not change in the mildor moderate CHF patients. In the recovery stage, T 3 and T 3/rT 3 increased significantly ( P <0 05, P <0 01) and rT 3 decreased significantly ( P <0 01).Conclusion In the acute stage of CHF, serum T 3, T 3/rT 3 decrease and rT 3 increase, while T 4 does not change in the severe patients. The determination of serum thyroid hormone is important in studying the pathogenesis of CHF and estimating prognosis.