冠心病介入诊治大剂量碘负荷对甲状腺功能及形态的近期影响

Short-term effect of large dosage iodine contrast on thyroid function and morphology in diagnosis and treatment of coronary heart disease

目的观察冠心病介入诊治过程中大剂量碘对比剂对甲状腺功能及形态的近期影响。方法将甲状腺功能正常的冠心病患者分为2组,冠状动脉造影50例为小剂量造影组,经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)50例为大剂量PCI组,分别于术前、术后2周测定游离三碘甲状腺原氨酸(free triiodothyronine,FT3)、游离甲状腺素(free thyroxine,FT4)、三碘甲状腺原氨酸总量(total tri-iodothyronine,TT3)、甲状腺素总量(total thyroxine,TT4)、促甲状腺激素(thyroid-stimulating hormone,TSH)、甲状腺过氧化物酶(thyroid peroxidase,TPO)抗体、甲状腺球蛋白抗体(thyro globulin antibody,TGAB)、甲状腺刺激抗体(thyroid stimulating antibody,TSAB)及甲状腺超声。结果术后2周2组TSH及FT3浓度较术前有所变化,差异均有统计学意义(P<0.05),但2组间差异无统计学意义(P>0.05)。术后2周2组FT4、TT3、TT4、TPO、TSAB、TGAB与术前差异均无统计学意义(P>0.05),2组间差异亦无统计学意义(P>0.05)。2组术前及术后2周甲状腺形态均无明显改变。结论冠心病介入诊治过程中大剂量碘对比剂对甲状腺功能近期存在亚临床甲状腺功能亢进的风险,近期对甲状腺形态无明显影响。

Objective To observe short-term effect of large dosage iodine contrast on thyroid function and morphology in diagnosis and treatment of coronary heart disease.Methods Fifty patients with normal thyroid function underwent coronary angiography.Fifty patients with normal thyroid function underwent percutaneous coronary intervention.The blood free triiodothyronine（FT3）,free thyroxine（FT4）,total tri-iodothyronine（TT3）,total thyroxine（TT4）,thyroid-stimulating hormone（TSH）,thyroid peroxidase（TPO）,thyro globulin antibody（TGAB）,thyroid stimulating antibody（TSAB）were measured and thyroid morphology were measured by ultrasonography before angiography and two weeks after the therapy.ResultsThere were significant changes of TSH and FT3 compared with before therapy after two weeks（P〈0.05）.But there was no significant change between two guoups.There were no significant changes of FT4,TT3,TT4,TPO,TSAB,TGAB after the 2 weeks compared with before therapy（P〉0.05）.And there was no change between two groups.There was no obvious change on thyroid morphology measured by ultrasonography after 2weeks.Conclusion There has risk of subclinical thyroid function hyperfunction with large dosage iodine contrast in diagnosis and treatment of coronary heart disease in the near future.There has no influence on thyroid morphology with large dosage iodine contrast in diagnosis and treatment of coronary heart disease in the near future.