左甲状腺素替代治疗对绝经后亚临床甲减患者心室结构和功能的影响

Effects of levothyroxine replacement therapy on ventricular structure and function in postmenopausal patients with subclinical hypothyroidism

目的探讨长期口服左甲状腺素片对绝经后亚临床甲减女性患者心室结构、功能的影响。方法随机选择50例确诊且未经治疗的患亚临床甲减的绝经后女性(研究组),给予左甲状腺素片替代治疗。以血清TSH达到正常水平为观察起点,治疗后1年为观察终点,检测血清FT3、FT4、TSH,并使用二维超声心动图检测心脏结构和功能相关指标。同时选择45例与研究组患者年龄相匹配的绝经后健康女性作为对照。结果研究组患者接受左甲状腺素替代治疗前后,左心室质量指数均高于对照组。治疗前,与对照组比较,研究组左心室舒张功能、收缩功能及左心功能受损,右心室室壁厚度、舒张功能及右心功能受损。上述指标在左甲状腺素有效替代治疗后1年均有改善。结论亚临床甲减对绝经后女性患者的左右心室的结构、收缩及舒张、心功能均有影响。左甲状腺素替代治疗能够改善心脏结构和功能。

Objective To investigate the effect of long-term oral levothyroxine treatment on the structure and function of left ventricle （LV） and right ventricle （RV） in postmenopausal patients with subclinical hypothyroidism （ SHT）. Methods Fifty untreated postmenopausal patients with SHT and 45 healthy control women were chosen as study group and control group. The thyroid hormone levels （FT3 ,Fl＇4 ,and TSH） were detected, and the structure and function of heart was evaluated by echocardiography. Patients in study group received levothyroxine replacement thera- py, and all the patients were followed up for a year after euthyroid state was achieved. Results The LV mass index in study group before and after levothyroxine replacement therapy was higher than that of control group （ P 〈 0. 05 ）. Com- pared with control group, the diastolic and systolic function and global function of LV decreased, and the wall thick- ness, diastolic and global function of RV decreased ; however, the above indexes were improved after 1 year of levothy- roxine replacement therapy. Conclusion SHT has effect on the structure, and systolic, diastolic and global function of LV, and levothyroxine replacement therapy can significantly improve the structure and function of heart.