慢性充血性心力衰竭外周甲状腺素水平变化

Alteration of peripheral thyroid hormone in patients with chronic congestive heart failure

目的 :观察评价慢性心血管病 ,尤其是慢性心衰患者甲状腺功能正常病态综合症 (SES)发生情况并探讨其病理生理意义。方法 :病史大于 2年的慢性心衰 (CHF)病人 5 4例和同期住院非CHF的慢性心血管病人 2 0例 ,病情平稳后抽取空腹血临床生化检验和甲状腺素测定。SES定义为血清总 3 碘甲腺原氨酸 (T3)低于正常值的低限 (<0 8ng/ml) ,4 碘甲腺原氨酸 (T4 )和促甲状腺素正常。结果 :74例受试者中有 33例发生SES ,CHF者发生率达 5 1% (2 8/ 5 4) ,SES的发生率随心功能不全加重而增高。SES与非SES的CHF病人心功能 (NYHA分级 )、左室舒张末径 (LVEDD)和射血分数 (LVEF)、T4 均值均有明显差异 ,但临床特征 ,肝、肾功能指标差别不显著。慢性心血管病人存在SES ,心功能不全程度越重 ,其发生率越高。结论 :肝、肾功能状态不是CHF病人发生SES的主要决定因素。认识CHF病人SES现象为临床综合治疗CHF可会提供一些非常有价值的思路。

? Objective:This study is to evaluate the prevelence and the pathophysiological significance of sick euthyroid syndrome in patients with chronic cardiovascular diseases,especially in chronic congestive heart failure(CHF).Method:The study population included 54 patients with chronic heart failure and 20 patients with chronic cardiovascular diseases.Blood sample were assessed after a fast\|night.SES was defined as the serum total triiodothyronine(T 3) level was less than the lowest normal limit (<0.8ng/ml)with the normal serum thyroid stimulating hormone and quiiodothyronine(T 4).Result:SES was founded in 33/74(44%)patients,as high as 51%(28/54)in CHF patients.The prevalence of SES increased as the degree of chronic heart failure increased.The function status(NYHA),end diastolic diameter and ejecton fraction of left ventricle and T 4 concentration in serum exited a significantly difference.between the CHF patients with and without SES,and the functional index of liver and kindey.physical characteristics did not exist significantly difference.Conclusion:The sick euthyroid syndrome presents in chronic cardiovascular diseases,and the higher of its prevalvence,the more severve of cardiac function insufficiency.The functional status of liver and kidney was not the major determinant of SES in CHF patients.To recognize the phenomenon of SES in patients with CHF may offer a valuable train of thought in management of CHF. 〔