老年慢性心力衰竭患者甲状腺激素的变化及其临床意义

Changes and clinical significance of thyroid hormones function in elderly patients with chronic heart failure

目的探讨老年慢性心力衰竭患者甲状腺激素的变化及其临床意义。方法收集老年慢性心力衰竭76例,其中心功能Ⅱ级25例,Ⅲ级28例,Ⅳ级23例,并选择30例非心力衰竭老年体检者作为对照组,以放射免疫法检测血浆总三碘甲状腺氨酸(T3)、总甲状腺素(T4)、游离三碘甲状腺氨酸(FT3)、游离甲状腺素(FT4)、促甲状腺素(TSH)。结果心功能Ⅱ级组T3[(1.28±0.51)nmol/L]和FT3[(3.01±0.78)pmol/L]与对照组[分别为(2.34±0.52)nmol/L和(4.27±0.64)pmol/L]比较,明显降低(均P<0.05),且随着心功能分级增加,心功能Ⅲ级、Ⅳ级T3和FT3水平则进一步降低(P<0.01),心功能Ⅲ级T3和FT3分别为(0.87±0.43)nmol/L和(2.42±0.61)pmol/L,心功能Ⅳ级T3和FT3分别为(0.60±0.36)nmol/L和(2.09±0.71)pmol/L。结论 T3和FT3作为重要的内分泌激素,参与心力衰竭的病理生理进程,可作为老年慢性心力衰竭患者早期临床诊断标志物。

Objective To investigate the changes and clinical significance of thyroid hormones function in elderly patients with chronic heart failure.Methods A total of 76 elderly patients with chronic heart failure were divided into different groups according to NYHA categorization：NYHAⅡgroup （25 patients）, NYHAⅢgroup （28 patients） and NYHA IV group （23 patients）.Thirty non-heart failure elderly subjects served as control group.T3 , T4 , FT4 , FT3 , TSH were tested by radioimmunoassay.Results Compared with T3 and FT3 levels [（2.34 ±0.52）nmol/L and （4.27 ±0.64） pmol/L respectively] in control group, T3 and FT3 levels[（1.28±0.51） nmol/L and （3.01 ±0.78） pmol/L respectively] in NYHAⅡgroup were decreased （P〈0.05）;and with the deterioration of cardiac function functional class Ⅲ-Ⅳ （P〈0.01）, patients showed T3 and FT3 levels [ （0.87 ±0.43） nmol/L and （2.42 ± 0.61） pmol/L respectively] in NYHAⅢgroup, and [ （0.60 ±0.36） nmol/L and （2.09 ±0.71） pmol/L respectively ] in NYHA IV group.Conclusions T3 and FT3 play an important role in chronic heart failure, can serve as the early predictors in elderly patients with chronic heart failure.