慢性充血性心力衰竭与甲状腺功能相关性探究

Research on correlation between chronic congestive heart failure and thyroid function

目的探析慢性充血性心カ衰竭患者不同阶段甲状腺激素(TH)的变化与临床价值。方法 40例慢性心カ衰竭患者接受抗心カ衰竭治疗后,对其血清甲状腺激素水平实施测定。将其治疗前后的甲状腺激素水平进行对比,同时对治疗前患者的甲状腺激素水平和心功能的相关性展开分析。结果治疗后三碘甲状腺原氨酸(T_3)、游离三碘甲状腺原氨酸(FT_3)指标为(0.72±0.46)、(1.96±0.82)pg/ml,高于治疗前的(0.47±0.15)、(1.22±0.45)pg/ml,差异有统计学意义(P<0.01);四碘甲状腺原氨酸(T_4)、游离甲状腺素(FT_4)、促甲状腺素(TSH)指标与治疗前比较差异无统计学意义(p>0.05)。心功能Ⅱ级的T_3、FT_3指标高于Ⅳ级,差异有统计学意义(P<0.05);各级T_3、FT_3指标与参考值比较,差异有统计学意义(P<0.01);各级T_4、FT_4、TSH指标与参考值比较,差异无统计学意义(p>0.05)。Ⅱ级与Ⅲ级、Ⅲ级与Ⅳ级甲状腺激素指标比较差异均无统计学意义(P>0.05),但随着心功能级别的升高,T_3、FT_3呈递减趋势。T_3、FT_3水平和心力衰竭严重程度呈显著负相关性(r=-0.836,P<0.01;r=-0.941,P<0.01),其中FT_3与心功能严重程度相关性更强,而T_4、FT_4、TSH与心功能严重程度无相关性(r=-0.405,P>0.05;r=-0.181,P>0.05;r=0.191,P>0.05)。结论患者心功能的恢复会使FT_3、T_3发生相应的显著变化,甲状腺激素水平的变化可作为评定慢性心力衰竭严重程度的指标,对疾病的分期、诊治及预后具有重要价值。

Objective To analyze change of thyroid hormones （TH） in different stages for chronic congestive heart failure patients, and its clinical value. Methods A total of 40 chronic congestive heart failure patients received anti-heart failure treatment, and their levels of serum thyroid hormones were detected. Levels of thyroid hormones were compared before and after treatment and analysis was made on correlation between chronic congestive heart failure and thyroid function before treatment. Results After treatment, there were triiodothyronine （T3） and serum free triiodothyronine （FT3） respectively as （0.72 ± 0.46） and （1.96 ± 0.82）pg/ ml, which were all higher than （0.47 ± 0.15） and （1.22± 0.45）pg/ml before treatment, and their differences had statistical significance （/9〈0.01）. There were no statistically significant difference in thyroxine （T4）, free thyroxine （FT4） and thyrotropic hormone （TSH） before treatment in two groups （P〉0.05）. Patients with cardiac function of grade H had lower T3 and FT3 than grade IV , and their differences had statistical significance （P〈0.05）. There was statistically significant difference in T3 and FT3 indexes at all levels and reference value （P〈0.01）. There was no statistically significant difference in T4, FT4, TSH at all levels and reference value （P〉0.05）. There was no statistically significant difference in grade II and grade III , grade III and grade IV （P〉0.05）, and T3, FT3 showed a trend of decline, with the increase of level of cardiac function. Level of T3 and FT3 had significant negative correlation to severity of heart failure （r=-0.836, P〈0.01 ; r=-0.941, P〈0.01）. FT3 showed higher correlation to severity of cardiac function, while T4, FT4, TSH showed no correlation to severity of cardiac function （r=-0.405, P〉0.05 ; r=-0.181, P〉0.05 ; r=0.191, P〉0.05）. Conclusion FT3 and T3 show significant corresponding change along with recovery of cardiac function, so change on level of thyroid hormone can be an indicator for evaluation of chronic heart failure severity, which contains important value for staging, treatment and prognosis of the disease.