慢性心力衰竭患者血清甲状腺激素水平变化和小剂量左甲状腺素干预效果观察

Study on changes in serum levels of thyroid hormones and effect of levothyroxine in treatment of patients with chronic heart failure

目的探讨慢性心力衰竭患者血清甲状腺激素水平变化和小剂量左甲状腺素干预效果。方法选择80例慢性心力衰竭(CHF)患者及50例健康者作为研究对象,比较两组三碘甲状腺原氨酸(T3)、甲状腺素(T4)、促甲状腺素(TSH)水平。将CHF患者随机分为干预组与常规组,常规组予利尿、扩血管等常规抗心衰治疗措施,干预组加用小剂量左旋甲状腺素片治疗,比较CHF患者治疗后超声心动图指标、血浆脑钠肽(BNP)水平等的变化。结果 CHF组T3水平明显低于对照组,差异有统计学意义(P<0.05),两组间T4、TSH水平比较差异无统计学意义(P>0.05);治疗后两组患者BNP及LVEDD、LVEF均较治疗前有显著改善,且观察组优于对照组,差异有统计学意义(P<0.05)。结论慢性心力衰竭患者常存在三碘甲状腺原氨酸水平下降,短期小剂量左旋甲状腺素治疗有助于患者心功能的改善,且具有较好的用药安全性。

Objective To explore the changes in serum levels of thyroid hormones and effect of levothyroxine in treatment of patients with chronic heart failure（ CHF）. Methods A total of 80 patients with CHF and 50 healthy persons were allocated in this study,serum levels of thyroid hormones were compared. These 80 patients with CHF were randomly divided into two groups,patients in conventional treatment group were treated with diuretic,vasodilator and other conventional anti-heart failure treatment,patients in intervention group were treated with small dosages of levothyroxine on the basis of conventional treatment,the echocardiographic indices and levels of BNP before and after treatment were compared in these two groups. Results The serum level of T3 in patients of CHF group was significantly lower than that of control group,the difference was statistically significant（ P 0. 05）,and there was no significant difference in serum levels of T4 and TSH（ P 0. 05）. The LVEDD,LVEF and level of BNP were significantly improved in comparison with those before treatment in these two groups,and those in intervention group were better than those of conventional group,and the difference was statistically significant（ P 0. 05）. Conclusion Patients with CHF are often associated with low serum level of T3,the short term treatment with small dosages of levothyroxine in patients with CHF can significantly improve their heart function with safety.