探讨甲状腺机能减退性心脏病患者的诊断及治疗方法

Methods of diagnosis and treatment of hypothyroid heart disease

目的 探讨甲状腺机能减退性心脏病患者的诊断及治疗方法。方法 甲状腺机能减退性心脏病患者48例,对患者采用甲状腺片口服的治疗方法 ,从小剂量（15~30 mg/d）开始逐渐加量,加至90~120 mg/d,并维持治疗,观察治疗效果。结果 治疗前射血前期（PEP）、射血期（ET）、射血前期与射血期比值（PEP/ET）、每搏输出量（SV）、心输出量（CO）、射血分数（EF）分别为（114±6）ms、（291±57）ms、（0.39±0.04）分、（72±8）ml、（4.2±0.7）L/min、（68±6）%,治疗后各项指标分别为（96±4）ms、（290±55）ms、（0.32±0.03）分、（86±6）ml、（5.4±0.8）L/min、（53±6）%,治疗前后比较差异具有统计学意义（P〈0.05）;心脏彩超检查显示心功能改善,且之前心脏扩大者心脏有回缩趋势,射血分数增加。结论 甲状腺机能减退性心脏病的起病症状不明显,进展缓慢,临床表现不典型,易被误诊,因此要与冠心病和心功能不全相鉴别。确诊方法为血清甲状腺功能测定,诊断中可采用超声心动图,对于其治疗,口服甲状腺片是一种安全有效的方法,预后较好。

Objective To investigate the methods of diagnosis and treatment for hypothyroid heart disease. Methods A total of 48 cases of hypothyroid heart disease were treated by oral administration of thyroid tablets. Beginning with a small dose （15-30 mg/d）, the amount was increased to 90~120 mg/d and maintained in the treatment. Reslldts The indexes of pre-ejection period （PEP）, ejection time （ET）, ratio of pre-ejection period and ejection time （PEP/ET）, stroke volume （SV）, cardiac output （CO）, ejection fraction （EF） were （114±6）ms, （291±57）ms, （0.39± 0.04）, （72 ±8）ml, （4.2 ± 0.7）L/rain, and （68 ±6）% before the treatment. The indexes after the treatment were （96 ±4）ms, （290± 55）ms, （0.32 ±0.03）, （86± 6）ml, （5.4 ±0.8）L/rain, and （53 ~ 6）%. Their difference had statistical significance （P〈O.05）. The result of ultrasonic cardiogram showed improvement of heart function, increased ejection fraction, and retraction trend of cardiac dilatation. Conclusion The onset symptoms of hypothyroid heart disease are not apparent, and its progress is slow. The clinical manifestation is not typical and can be easily misdiagnased. Therefore it should be distinguished from coronary heart disease and cardiac insufficiency. The diagnosis method is the determination of serum thyroid function. Ultrasction Heasonic Heartbeat diagnosis can he used. For the treatment method, oral administration of thyroid tablets is a safe and effective method and the prognosis is good.